Objective To explore the value of echocardiography in the diagnosis of the criss-cross heart. Methods The echocardiographic results of 6 patients with the criss-cross heart were reviewed retrospectively. The echocardiographic characteristics were analyzed and compared with the surgery results in 4 operated cases. Results The 6 cases were interpreted as representing a criss-cross heart with solitus atria,D-loop ventricles and concordant atrioventricular connections. The ventriculo-arterial alignments of 5 cases were abnormal including double outlet right ventricle with anterior aorta in 2 and transposition of the great arteries in 3 while 1 patient had concordant connection. The following principal characteristics were tilting the transducer from posterior to anterior could demonstrate the connection of the left-sided left atrium and the right-sided left ventricle through mitral valve at first. The more anterior angulation of the transducer then showed the right-sided right atrium was connected to the left-sided right ventricle through tricuspid imaging displayed the two atrial outflows crossed each other without mixing at atrioventricular valve level.right ventricle often occured. The echocardiographic diagnosis of the criss-cross heart and its associated cardiac abnormalities were confirmed by surgery in 4 cases except 1 persistent left superior vena cava was missed. Conclusions The invisibility of a standard 4-chamber view in any cut was very characteristic in the echocardiographic diagnosis of the criss-cross heart. The definitive appearance was the separate display of the two ventricular inlets and the crossed atrioventricular connections with each atrium emptying into the contralateral ventricle by continuous subxiphoid or apical scanning. The transthoracic echocardiography can diagnose this rare heart disease and associated cardiac abnormalities accurately.

Objective To investigate the value of left ventricular global two-dimensional strain and strain rate index measured by two-dimensional speckle tracking imaging (2D-STI) in assessing myocardial injury in various degree of rats following acute myocardial infarction. Methods Fifty-five Wistar rats were randomly divided into myocardial infarction(MI) group ( n =45) and sham-operation(SO) group ( n = 10).To establish rats acute myocardial infarction model with different infarct extent, MI group were randomly divided into MI15 group,MI30 group and ML60 group( n = 15,respectively) which underwent occlusion of left anterior descending coronary artery for 15 minutes, 30 minutes and 60 minutes respectively. Echocardiography was performed at baseline and 24 hours after reperfusion. High frame rate twodimensional images were recorded from the left ventricular short-axis views at the papillary muscle level.Left ventricular global circumferential strain(GSc) and strain rate(GSRc) were measured using EchoPAC work station. Left ventricular internal diameter at diastole (LVIDd) and systole ( LVIDs), fractional shortening(FS) and ejection fraction(EF) were measured by anatomical M-model echocardiography. Area of necrosis(AN) of each segment was measured after triphenyl tetrazolium chloride(TTC) staining. Results ① Compared with baseline and SO group, LVIDd and LVIDs of MI15, MI30 and MI60 group significantly increased respectively,whereas FS and EF significantly decreased( P <0. 05). Compared with MI15 group and MI30 group, LVIDd and LVIDs of MI60 group significantly increased, whereas FS and EF significantly decreased(P <0. 05). ② Compared with baseline and SO group,GSc and GSRc of MI15 group, MI30 group and MI60 group significantly decreased. GSc and GSRc of MI group decreased with ischemia duration ( P <0.05). ③ GSc and GSRc significantly correlated with AN respectively ( P <0. 01) while the correlation coefficient was 0. 90 and 0. 88 respectively, and GSc and GSRc were significantly predictors of AN( P <0.01) while the Beta was 0.558 and 0.491 respectively.④AN increased with ischemia duration( P <0.05). Conclusions Left ventricular global circumferential strain and strain rate index measured by 2D-STI,which decreased significantly as the area of necrosis increased, can accurately assess myocardial injury after myocardial infarction in various degree.

Objective To investigate the value of two-dimensional speckle tracking imaging (2D-STI) in assessing left ventricular global and regional myocardial function in normal rats. Methods Echocardiography was performed during low-dose dobutamine stress in 20 normal adult male Wistar rats. High frame rate of 2D images were recorded from the left ventricular short-axis views at the papillary muscle level. Peak systolic radial strain (PRS) and circumferential strain (PCS) of each segment, left ventricular global peak systolic radial strain (G_(PRS)) and circumferential strain (G_(PCS)) were measured at EchoPAC work station. Left ventricular internal diameter at diastole (LVIDd), systole (LVIDs), fractional shortening (FS) and ejection fraction (EF) were measured with anatomical M-model echocardiography. Dynamic changes of each index during stress experiment were observed. The correlations between EF and left ventricular global two-dimensional strain (G_(PRS), G_(PCS)) were analyzed respectively. Results PRS was similar in all segments of mid-ventricular in short-axis view (P>0.05) at baseline, while PCS of each segment showed heterogeneity, with the anteroseptal and anterior wall showing the largest value and the inferior wall showing the lowest value (P<0.05). G_(PRS), G_(PCS), PRS and PCS of each segment increased correspondingly when the dobutamine dose increasing, as well as FS and EF, whereas LVIDd and LVIDs decreased. When dobutamine dose was 10.0 μg/(kg·min), these parameters were not significantly different compared with those of 5.0 μg/(kg·min) (P>0.05). Conclusion With good reproducibility, 2D-STI can noninvasively and easily assess global and regional left ventricular myocardial deformation of normal rats at rest and during low-dose dobutamine stress.

Quantification of right ventricular (RV) volume and function remains a challenge because of RV complex geometry by conventional echocardiography. The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot (TOF) by 2-dimensional ultrasound speckle tracking imaging (STI). Thirty-eight patients with TOF were enrolled in this study and divided into child group (n=25) and adult group (n=13) according to age. Thirty-eight age- and sex-matched normal subjects were selected as control groups including child control group (n=25) and adult control group (n=13). RV global longitudinal peak systolic strain (GLS), strain rate (GLSR(s)), early diastolic strain rate (GLSR(e)) and late diastolic strain rate (GLSR(a)) were measured in all subjects by STI from the apical 4-chamber view and compared between groups. Furthermore, the main factors affecting the RV global longitudinal functional parameters were assessed. Compared with those in controls, RV GLS, GLSR(s) and GLSR(e) were significantly reduced in patients with TOF (P<0.05 for all). RV GLSR(s) was significantly decreased in adult patients with TOF as compared with that in child patients (P<0.05). There was no significant difference in RV GLS, GLSR(e) and GLSR(a) between child and adult TOF groups (P>0.05). The diameter of right ventricle, main pulmonary artery and ventricular septum defect had correlations with RV GLSR(s) (r ( 1 )=-0.490, r ( 2 )=0.580, r ( 3 )=-0.528, respectively, P<0.05 for all). Tricuspid annular plane peak systolic velocity (Sm) was the independent predictor of RV global strain and strain rate (beta(1)=0.355, P (1)=0.031, beta(2)=0.307, P (2)=0.021). RV global longitudinal function is decreased in patients with TOF, especially in adult patients. STI is a sensitive and accurate technique in RV global functional assessment.

Quantification of right ventricular(RV)volume and function remains a challenge because of RV complex geometry by conventional echocardiography.The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot(TOF)by 2-dimensional ultrasound speckle tracking imaging(STI).Thirty-eight patients with TOF were enrolled in this study and divided into child group(n=25)and adult group(n=13)according to age.Thirty-eight age-and sex-matched normal subjects were selected as control groups including child control group(n=25)and adult control group(n=13).RV global longitudinal peak systolic strain(GLS),strain rate(GLSPs),early diastolic strain rate(GLSRe)and late diastolic strain rate(GLSRa)were measured in all subjects by STI from the apical 4-chamber view and compared between groups.Furthermore,the main factors affecting the RV global longitudinal functional parameters were assessed.Compared with those in controls,RV GLS,GLSRs and GLSPe were significantly reduced in patients with TOF(P<0.05 for all).RV GLSRs was significantly decreased in adult patients with TOF as compared with that in child patients(P<0.05).There was no significant difference in RV GLS,GLSRe and GLSRa between child and adult TOF groups(P>0.05).The diameter of right ventricle,main pulmonary artery and ventricular septum defect had correlations with RV GLSRs(r1=-0.490,r2=0.580,r3=-0.528,respectively,P<0.05 for all).Tricuspid annular plane peak systolic velocity(Sm)was the independent predictor of RV global strain and strain rate(β1=0.355,P1=0.031,β2=0.307,P2=0.021).RV global longitudinal function is decreased in patients with TOF,especially in adult patients.STI is a sensitive and accurate technique in RV global functional assessment.

Objective To evaluate left ventricular torsion (LVtor) and twist of different segments in systolic phase of healthy infants, children and adolescents with two-dimensional ultrasound speckle tracking imaging (STI). Methods One hundred and seventeen healthy subjects aged from 3 days to 15 years were divided into 5 groups: infants (3 days-2 years), pre-school age children (3-5 years), school age children (6-9 years), preadolescent (10-12 years) and adolescent age (13-15 years). Basal and apical short-axis images of left ventricle were acquired to analyze torsion of every segment and LV torsion. The peak twist (Ptw) of left ventricular was calculated, and the values of different groups were compared. Results ①Seen from the apex level, the normal LV performed wringing motion with clockwise rotation at the base and counterclockwise rotation at the apex in infants, children and adolescents. ②Seen from the short-axis basal level, torsion angle was the biggest in inferior, but the smallest in anterior in same age group (P<0.05). In different age group, there was no statistical difference in torsion angle at basal level. ③Torsion angle of short axis apex level increased with age increasing, and reached peak in adolescents. No statistical difference was found in torsion angle of every segments in apical level among subjects in the same age group. ④Torsion angle of every segment in apical and basal level changed with age increased while ventricular wall rotating mainly with apical plane gradually. In adolescents, significant difference was found in torsion angle in same segments between basal and apical plane (P<0.01). ⑤Torsion of the basal plane of left ventricular changed with age increasing, but no statistical difference was found. Torsion of the apical plane of left ventricular increased with age increasing (P<0.05). Ptw of left ventricular increased with age increasing, and reached the peak in preadolescence and adolescence. ⑥No statistical difference was found in all parameters of torsion and rotation between males and females. Conclusion LVtor in every segment in apical plane and Ptw of left ventricular increase with age increasing before adolescence.

Objective To assess the value of quantitative color Doppler sonography in patients with systemic lupus erythematosus (SLE). Methods The right renal in 21 patients with SLE and 22 normal subjects were examined with Philips IU22 ultrasonic diagnostic device. Resistence index (RI) of interlobar artery and interlobular artery were measured with color Doppler sonography, vascularity index (VI), flow index (FI) and vascularization flow index (VFI) which reflecting the renal cortical blood flow were calculated with quantitated analysis software. All the parameters between two groups were compared and analyzed. Results The color signals of renal cortical blood flow in patients with SLE were inferior to those of the normal group, especially in the area near the edge of renal. No statistical difference of RI was found between the two groups (P>0.05), while VI, FI and VFI in SLE group were significantly lower than those of the normal group (VI, VFI, P<0.01, FI, P=0.01). Conclusion Color Doppler sonography combined with blood flow quantitative technique provide a helpful, sensitive and convenient tool to detecte the renal changes in SLE patients.

Objective To assess the characteristic of left ventricular systolic longitudinal strain(SL) in healthy children and its relationship with age by speckle tracking imaging(STI). Methods One hundred and thirty healthy children were divided into 5 groups: classing 0 to 3 years old children together as group A,and 3 to 5 years old as group B,6 to 9 years old as group C,10 to 12 years old as group D,13 to 18 years old as group E. SL of left ventricular wall during the systole was measured. Results ①The apical SL of left ventricular wall during the systole was larger than the middle one and the basal one. Significant differences were found between apical and basal segments in group A. The apical segments of posterior wall, inferior wall ,lateral wall and ventricular septum presented significant differences with the basal one in group D. Significant difference was found between apical segments of the posterior ventricular septum and the basal one in group E. ②These parameters of the five groups trend to decrease as well as the growth of age . Compared with group D and E,SL of left ventricular wall during the systole were significantly increased in group A except anterior wall,and SL of left ventricular wall during the systole were significantly increased in group B except apical segments of the posterior wall and apical segments of the anterior ventricular septum. ③The intra-observer and inter-observer variabilities were 2.0% and 2.5% for SL measured by STI in two chamber view,1.9% and 2.3% SL in three chamber view, and 2.1% and 2. 8% in four chamber view. Conclusions The parameters of strain were not similar in left ventricular different walls and segments,and there is some relationship between SL and increasing-age.

Objective To analyze the left ventricular(LV) rotation and twist by two-dimensional ultrasound speckle-tracking imaging(STI),and evaluate the correlation between twist and other components of LV contraction in uremia patients. Methods Twenty-nine uremia patients and twenty-nine healthy volunteers were included. High frame rate two-dimensional images were recorded from the left ventricular short-axis views both of the basal and apical planes. Segmental and global LV rotation were recorded at both The peak systolic LV twist was significantly decreased in uremia patients(P <0. 001). The loss of LV twist occurred mainly by the impairment of maximal global counterclockwise apical rotation(P <0. 001),and was augmented by somewhat less reduction in global clockwise basal rotation although the differences was not significantly reduced(P<0.01), while only the posterior and inferior of the basal plane was significantly fraction(r=0.645,P=0.000), LV end-diastolic volume (r=-0.549,P=0.002), LV end-systolic volume(r=-0.673, P = 0.000) in uremia patients. Conclusions STI enables quantification of segmental and global LV rotation in an objective manner in uremia patients,and provides a new method for evaluation of segmental and global LV systolic function.

Objective To evaluate the early change of left ventricular (LV) systolic function in patients with type 2 diabetes mellitus(T2DM) by ultrasound speckle tracking imaging. Methods Ninety-five subjects were included:40 T2DM with normal LV ejection fraction (LVEF≥50% ,group A),20 T2DM with abnormal LVEF (LVEF<550 %) (group B), and 35 normal controls. Two-dimensional strain images were acquired from LV short-axis view. LV peak systolic global and segmental radial strain and circumferential strain at the levels of mitral annulus, papillary muscle and apex, and LV systolic global and segmental rotation at the levels of mitral annulus and apex and LV peak systolic global twist were assessed. Results In group A, compared with control group, LV peak systolic radial strain parameters were not significant difference (P >0.05), peak systolic circumferential strain of part segments, average peak strain of each plane and global strain were reduced (P <50.05～0.001) ,and LV peak systolic rotation of all apical segments, peak systolic global rotation at the levels of mitral annulus and apex,and peak systolic global twist were significantly increased (P <0.05～0.001). Compared with control group and group A,all LV systolic radial strain and circumferential strain parameters, LV systolic global and segmental rotation and peak systolic global twist in group B were significantly reduced (P <0.05 ～ 0.001). Conclusions Speckle tracking imaging could be used to evaluate the early change of LV torsional deformation and LV systolic function in T2DM.