Objective:To investigate the effect of instantaneous flow rate on the consistency of diagnostic accuracy of severe degenerative mitral regurgitation (DMR) using proximal isovelocity surface area (PISA).Methods:From June 2019 to June 2021, 75 patients with DMR who underwent echocardiography in Department of Echocardiography of Zhongshan Hospital, Fudan University were prospectively enrolled. The instantaneous flow rate of DMR during the systolic phase was calculated using M-mode PISA(PISA M-mode), and a time-integrated curve was plotted. Regurgitant volume (RVol) and effective regurgitant orifice area (EROA) were calculated by traditional PISA (PISA max), pair PISA (PISA pair), and PISA M-mode, respectively. RVol acquired from cardiac magnetic resonance (CMR) volumetric method in 22 patients of the enrolled patients. The correlation and consistency of RVol acquired between the three PISA methods and CMR were compared. Agreement of diagnostic accuracy of severe mitral regurgitation (sMR) acquired between the three PISA methods and multi-parameter algorithm by American Society of Echocardiography (ASE) was analyzed using Cohen′s Kappa analysis. Results:The curve of instantaneous flow rate of DMR showed unimodal pattern with the peak at mid-late systolic phase. The correlation of RVol acquired between PISA methods and CMR was moderate for PISA max and PISA pair ( r=0.77, 0.80, both P<0.001), whereas PISA M-mode presented strong correlation with CMR ( r=0.87, P<0.001). RVol acquired from PISA max was larger than that of CMR[(69.1±37.1) ml vs (49.0±29.0)ml, P=0.002]. Both PISA max and PISA pair were shown moderate agreement of diagnostic accuracy of sMR with ASE multi-parameters algorithm (RVol: κ=0.496, 0.525, both P<0.001; EROA: κ=0.570, 0.578, both P<0.001), while PISA M-mode presented strong agreement (RVol: κ=0.867 and EROA: κ=0.802, both P<0.001). Conclusions:Based on the unimodal pattern of instantaneous flow rate in patients with DMR, PISA max may significantly overestimate RVol, exposing a significant proportion of patients with DMR to unnecessary MR surgery. PISA M-mode presents better correlation and consistency with CMR on the quantification of RVol compared with PISA max and PISA pair, and may improve the diagnostic accuracy of quantification of sMR using PISA.

Objective To evaluate the role of transthoracic echocardiography ( T T E ) and transesophageal echocardiography( T EE) in the process of transapical mitral valve repair using a novel edge‐to‐edge device( ValveClamp) and this device′s efficacy and safety in a preliminary clinical trial . Methods Six patients with moderate to severe or severe degenerative mitral regurgitation ( DM R) confirmed by T T E and T EE were enrolled . T T E was performed pre and post procedure as well as 30 days post procedures . Related cardiac structure and hemodynamic parameters ,including mitral regurgitation area ( MRA‐max ) , vena contracta width ( VCW ) ,mitral valve effective orifice area ( M VEOA ) ,left ventricular end diastolic diameter ( LVEDD ) , left ventricular end systolic diameter ( LVESD ) , left ventricular ejection fraction ( LVEF) ,max and mean mitral valve pressure gradient ( M VPG‐max and M VPG‐mean) were recorded and evaluated in a central core laboratory . Results All the procedures were successfully performed .M RA‐max , VCW and M VEOA decreased significantly post procedures ( all P ＜ 0 .000 ) , and they remained no significant changes within 30 days post procedures ( all P ＞ 0 .05 ) . M eanwhile ,M VPG‐max and M VPG‐mean slightly increased ( all P ＜0 .01 ) and left atrial anterior‐posterior dimension attenuated 30 days post procedures( P ＜0 .05) ,but all M VPG‐mean were lower than 5 mm Hg ( 1 mm Hg＝0 .133 kPa) . T here were no significant changes in other hemodynamic parameters ( all P ＞ 0 .05) . Conclusions T ransapical mitral valve repair using ValveClamp can be performed safely and a significant reduction in mitral regurgitation can be achieved in patients with DM R . T EE and T T E facilitate the patient selection for ValveClamp procedures as well as perioperative navigation and assessment .

Objective:To explore the effects of the LAmbre device and mitral annulus(MA), as well as left atrium(LA) in patients with non-valvular atrial fibrillation(NVAF) after left atrial appendage closure (LAAC) using real-time-three-dimensional transesophageal echocardiography (3D TEE).Methods:Fity-six consecutive patients who underwent LAAC with the LAmbre device in Zhongshan Hospital of Fudan University from June 2019 to March 2023 were retrospectively enrolled, with no or less than moderate mitral regurgitation (MR). All patients underwent pre-operative and follow-up two-and three-dimensional transesophageal echocardiography (2D TEE, 3D TEE) at 60 days after the operation. The quantitative parameters of MA and LA were obtained by offline analysis using QLab 13.0 (Philips Healthcare, Andover, MA). Importantly, mitral annular measurements were made at seven time points throughout the cardiac cycle: early diastole, mid-diastole, late diastole, mitral valve closure, early systole, mid-systole, and late systole, which facilitates constructing the dynamic model of MA to assess the annular morphology and dynamics.Results:The values of AP diameter (APD), AL-PM diameter (ALPMD), 3D annulus circumference (3DAC), 3D annulus area (3DAA) decreased significantly compared with pre-operative values at all time points of the cardiac cycle (all P<0.05), while non-planar angle (NPA) and AH/CD were not apparently changed (all P>0.05 ). Throughout the cardiac cycle, MA showed regular changes, gradually increased in systole with the saddle shape deepened, and gradually decreased in diastole with the saddle shape shallowed.During systole, there was an increase in the rate of change of AP in MA [pre-operative (3.01±2.64)%, post-operative (3.81±3.51)%, P=0.037] after LAAC, with no significant difference in the rate of change of ALPM, 3DAC, and 3DAA.Meanwhile, we observed an evident reduction in LA minimal volume (LAVmin) [pre-operative (78.36±25.16)ml, post-operative (70.73±22.78)ml, P=0.004] and an obvious increase in LA ejection function [pre-operative (22.88±10.09)%, post-operative (31.41±12.28)%, P<0.05] during follow-up. Conclusions:3D TEE can accurately assess the impact of LAAC on the MA and LA. The LAmbre device can affect the morphology of MA, as well as the structure and function of LA, while the change of the dynamics of MA is not so prominent.

Objective To evaluate the usefulness of real-time three-dimensional intraoperative epicardial echocardiography ( RT-3D IEE) in the process of transapical mitral valve repair and a new device's efficacy in an animal model . Methods Acute mitral regurgitation ( MR) was induced in 18 anesthetized domestic pigs as MR group by cutting chordae supporting the segment of the leaflet ( A2 , n = 9 ; P2 , n = 8 ;P3 , n = 1) ,while 15 pigs received no cutting chordae were chosed as normal mitral valve ( NMV ) group . The ValveClamp procedures were then transapically performed either on the prolapsing segment ( MR group) or A2/ P2 segment ( NMV group ) respectively solely under 3D epicardial echocardiographic guidance . Epicardial echocardiography was obtained before and after transcatheter interventions . Thirty days later all pigs were humanely killed to verify the location of implanted devices . Results In normal group , the preoperative max and mean mitral valve pressure gradient was higher than postoperative those ( P < 0 .0001) ,and no significant difference was found in other echocardiographic parameters . In MR group , the preoperative echocardiography showed that cutting the leaflet chordae caused severe ( n = 15 ) or moderate( n = 3) MR ,while postoperative immediate echo observed overt MR area reduction( P < 0 .0001) with 8 cases to slight ,5 cases to mild and 1 case eliminated .Furthermore ,the mean postoperative and max mitral valve pressure gradient significantly increased both in two groups ( P < 0 .0001 ) ,whereas no complications or other structural changes were observed ( P > 0 .05) .The autopsy report demonstrated that all ValveClamp devices were precisely placed to clamp either the prolapsing segments (MR group) of mitral valve or A2/P2 segments (NMV group) ,respectively .Conclusions Real-time three-dimensional epicardial echocardiography can independently monitor the new transcatheter mitral repair technique-ValveClamp , facilitating the overall procedure . Transapical implantation of ValveClamp device under epicardial echocardiographic guidance is effective in reducing acutely induced mitral regurgitation .

Transcatheter tricuspid valve intervention is the new frontier of interventional cardiology. The LuX-Valve is a radial force-independent orthotopic tricuspid valve replacement device developed in China. The LuX-Valve Plus transcatheter tricuspid valve replacement (TTVR) system is changed from the trans-atrial to the transjugular approach, which further reduces trauma and pulmonary complications compared with the first generation LuX-Valve. The first-in-human study has been completed at Zhongshan Hospital, Fudan University and an exploratory multicentre clinical study is underway. Echocardiography plays an important role in pre-TTVR screening, intraoperative guidance and postoperative evaluation and follow-up, especially two-dimensional transoesophageal echocardiography (2D-TEE) and three-dimensional transoesophageal echocardiography (3D-TEE). However, there is a lack of appropriate intraoperative guidance and assessment protocols. In this study, we briefly described the protocols and imaging considerations for intraoperative 2D-TEE and 3D-TEE to ensure the successful implantation of TTVR.

Tricuspid regurgitation (TR) interventions are under rapid development. The K-Clip? system is the first domestic transcatheter tricuspid annuloplasty system with unique clamping procedure to achieve annular reduction.Intraoperative echocardiographic monitoring procedures for transcatheter tricuspid annuloplasty have not been reported yet in China. Thus, this review aimed to propose the standard two-dimensional and three-dimensional transesophageal echocardiographic workplanes and procedures to guide and monitor the implantation of K-Clip system based on our experience in Zhongshan Hospital, Fudan University to provide a reference point for the intraoperative echocardiographic monitoring of future transcatheter tricuspid annuloplasty devices in China.

Objective To evaluate the diagnostic value of myocardial work related parameters in coronary ischemia patients with coronary artery disease (CAD) coronary ischemia using non-invasive left ventricular pressure strain loop (PSL), taking fraction flow reservation (FFR) as the gold standard. Methods From December 2020 to December 2021, 53 clinically suspected CAD patients were prospectively enrolled. All patients underwent echocardiography, invasive coronary angiography and FFR measurement. According to the results of coronary angiography, patients were divided into myocardial ischemia group (n=24, FFR≤0.80) and non-myocardial ischemia group (n=29, FFR＞0.80). PSL was used for off-line analysis to obtain the global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) , global positive work( GPW) , and global systolic constructive work (GSCW) and other myocardial work parameters. The differences of parameter values between the two groups were compared. The diagnostic efficacy of work parameters in myocardial ischemia was analyzed by ROC curve. Results Compared with the non-myocardial ischemia group, GWI, GCW, GPW and GSCW were significantly decreased in the myocardial ischemia group at the 18-, 16-, and 12-segment levels (P＜0.001). The ROC curve showed that the AUC results of GWI, GCW, GPW, GSCW at the 18-segment level were 0.803(95%CI 0.679-0.927), 0.807(95%CI 0.687-0.928), 0.822(95%CI 0.708-0.936), 0.819(95%CI 0.703-0.935). The optimal cut-off value of GWI was 1 676.3 mmHg%, and the sensitivity, specificity and accuracy of predicting myocardial ischemia were 70.8%, 86.2% and 79.2%, respectively. The optimal cut-off value of GCW was 1 999.4 mmHg%, and the sensitivity, specificity and accuracy of predicting myocardial ischemia were 75.0%, 82.8% and 79.2%, respectively. Conclusions Analyzing myocardial work using PSL has good significance for screening suspected myocardial ischemia in CAD patients.