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.

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 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 .

Objective To evaluate the left ventricle systolic function in patients with aortic stenosis (AS) underwent transcatheter aortic valve implantation(TAVI) by speckle tracking imaging and to observe the indicators in bicuspid aortic valves(BAV) and tricuspid aortic valves(TAV) groups.Methods Twenty nine patients with AS were enrolled,all of them underwent TAVI successfully.The regular echocardiography and 3D full-volume images were acquired on before and 3 days,1 month after TAVI.Longitudinal strain,circumferential strain,and three-dimensional left ventricle ejection fraction(3D-LVEF) were analyzed using Qlab software.Results Compared with the baseline,aortic valve blood flow velocity (AV),maximum aortic valve pressure gradient (AVPG-max),mean aortic valve pressure gradient (AVPG-mean),aortic valve area(AVA) after TAVI were improved significantly.Global longitudinal strain(GLS) had a improvement on 3 days after TAVI(all P ＜0.001),and further increased during 1 month after TAVI (all P ＜0.001).Global circumferential strain(GCS) were increased during 1 month after TAVI(all P ＜ 0.001).The 3D-LVEF after 1 month were improved significantly(all P ＜0.001).The BAV patients and TAV patients had similar changes in all of indicators observed.Conclusions The left ventricle systolic function has early improvement after TAVI,and further recovery during follow-up.The BAV patients can obtain a benefit from TAVI equally to the TAV patients.

Human resource,as the core resource of hospitals,plays a key role in maintaining the competitive advantage of the hospitals.From the perspective of system engineering,this paper closely combined the present situation of human resource management under the background of medical staff shortage with the systematic theory,and systematically analyzed the problems of medical staff shortage and human resource management in public hospitals on the basis of literature research and investigation.It constructedand analyzed the archetype of “growth upper limit” that the over load of medical staff in hibited their mental health,“growth and investment insufficiency” archetype of medical staff's human capital investment,and the “trifles” archetype of medical personnel shortage.As well,it put forward the problem-solving management strategy using the theory of systematic thinking.

Objective To investigate the alternation of right ventricular volume and systolic function in patients with severe pulmonary regurgitation under percutaneous pulmonary valve implantation(PPVI) by real-time three-dimensional echocardiography(RT-3DE).Methods Ten patients with severe pulmonary regurgitation were enrolled.The 2D echocardiography images and real-time 3D full volume images on apical four-chamber view on a Philips IE33 system were acquired before PPVI and at 3 days,1 month,3months and 6 months after PPVI.Right ventricular end diastolic volume (EDV),end systolic volume(ESV),stroke volume (SV),ejection fraction(EF),fractional area change(FAC),tricuspid annular plane systolic excursion (TAPSE),right ventricular longitudinal strain-free wall(RVLSf) and right ventricular longitudinal strainseptum(RVLSs) were analysed using off-line TomTec software,the differences among the five groups were compared,and correlation analysis was made between the CMR and RT-3DE measurements.Results The level of pulmonary regurgitation had decreased or disappeared after PPVI.Compared with the preoperation,EDV,ESV at 3 days,1 month,3months and 6 months after operation had decreased significantly.EF,FAC,TAPSE,RVLS had increased significantly(all P ＜0.05).There were close correlation in EDV,ESV,EF between RT-3DE and CMR(pre-operation r =0.811,0.817,0.807,post-operation r =0.735,0.834,0.800,all P ＜0.055).Conclusions RV volume notably decreases while RV systolic function remarkably improves.The RT-3DE is a helpful technology in the evaluation of right ventricular volume and systolic function in patients after PPVI.

Objective To investigate the value of two-dimensional and three-dimensional transesophageal echocardiography (3DTEE) in transcatheter aortic valve implantation (TAVI). Methods Eleven patients with severe aortic stenosis and one patient with moderate to severe prosthetic valve regurgitation underwent TAVI in Zhongshan Hospital of Fudan University from May 2010 to December 2015. All patients received two-dimensional and three-dimensional transthoracic and transesophageal echocardiographic examination before surgery, during and after surgery.Results Procedural success was achieved in eleven patients, but one patient died in pericardial tamponade and aortic dissection three days after TAVI. The maximum and minimum diameter of aortic annule, the area of aortic annule and aortic valve were measured by multidetector computed tomography (MDCT) and 3DTEE before surgery. All parameters had strong correlations between MDCT and 3DTEE (r=0.98,P<0.01 for maximum diameter;r=0.97,P<0.01 for minimum diameter;r=0.97,P<0.01 for the area of aortic annule;r=0.99, P<0.01 for the area of aortic valve). There were good correlations for the area of aortic valve among MDCT, 3DTEE and equation of continuity (allr=0.99,P<0.01).ConclusionTwo-dimensional and three dimensional transesophageal echocardiography can quantify the size of aortic annular and comprehensively evaluate the anatomical structure of aorta rapidly and accurately, which can be used in guiding TAVI and monitoring its complications in real time.

Objective To investigate the difference between three-dimensional transesophageal echocardiography ( 3DTEE) and CT in measuring the size of aortic ring and the height of coronary ostium . Methods Fifteen patients were recruited and were treated with the transcatheter aortic valve implantation ( TAVI) . Routine transthoracic echocardiography ,two-dimensional echocardiography ( 2DTEE) ,3DTEE and CT examinations were taken preoperatively . Results The minimal diameter ,maximum diameter , perimeter ,area of the aortic ring measured by 3DTTE showed a close correlation and a strong consistency with those measured by CT [ r = 0 .88 , P < 0 .0001 ,ICC = 0 .928 (0 .788 - 0 .976) ; r = 0 .81 , P = 0 .0003 , ICC = 0 .890 ( 0 .673 - 0 .963) , r = 0 .85 , P = 0 .0001 ,ICC = 0 .914 ( 0 .744 - 0 .971) ; r = 0 .88 , P <0 .0001 ,ICC = 0 .932 (0 .799 - 0 .977) ] .The ostium height of the left and right coronary arteries measured by 3DTEE also showed a close correlation and a strong consistency with those measured by MDCT [ r =0 .87 , P < 0 .0001 ,ICC = 0 .923 ( 0 .777 - 0 .975) ; r = 0 .82 , P < 0 .0002 ,ICC = 0 .897 ( 0 .693 - 0 .965) ] . Besides ,inter-observer and intra-observer reproducibility for 3DTEE measurement data were very good . Conclusions 3DTEE has a high repeatability in evaluating minimal diameter , maximum diameter , perimeter ,area of the aortic ring and the height of coronary ostium ,which also shows good correlation with those measured by CT .

Purpose To evaluate the correlation among diffusion weighted imaging (DWI), tumor Cellularity and hypoxia-inducible factor-1α (HIF-1α) for the high and low grade astrocytoma. Materials and Methods DWI was applied with 33 patients with astrocytoma confirmed by pathology, and ADC value was measured. Tumor Cellularity was measured using Scion Image 4.0.3.2. The expression of HIF-1α was tested using immunohistochemisty. Results Mean ADC value was higher in the low grade astrocytoma than that in the high grade astrocytoma (t=7.300, P<0.001). The tumor Cellularity was higher in the high grade astrocytoma than that in the low grade astrocytoma (t=-3.845, P<0.01). HIF-1αexpression could be demonstrated in the low grade [(20.08±10.01)%] and high grade [(47.91±19.03)%] astrocytoma. The negative correlation was demonstrated between ADC value and HIF-1αand tumor Cellularity (r=-0.756,-0.617;P<0.001). The positive correlation was demonstrated between HIF-1αand tumor Cellularity (r=0.622, P<0.001). Conclusion ADC value can be used to discriminate the low and high grade astrocytoma, and the role of HIF-1αshould be further to study with enlarged sample.