Global Longitudinal Cardiac Strain and Strain Rate for Assessment of Fetal Cardiac Function: Novel Experience with Velocity Vector Imaging

Background: Cardiac strain and strain rate are new methods to quantitate fetal cardiac function. Doppler-based techniques are regional measurements limited by angle of insonation. Newer feature-tracking algorithms permit angle independent measurements from two-dimensional datasets. This report describes the novel measurement of global strain, strain rate, and velocity using Velocity Vector Imaging (VVI) in a group of fetuses with and without heart disease. Methods: Global and segmental longitudinal measurements were performed on the right and left ventricles in 33 normal fetuses and 15 fetuses with heart disease. Segmental measurements were compared to global measurements. Clinical outcome data were recorded for fetuses with heart disease. Results: Forty-eight fetuses were evaluated with VVI. Cardiac strain and strain rate in normal fetuses were similar to normal adult values, but lower than pediatric values (LV strain =− 17.7%, strain rate −2.4/sec; RV strain =−18.0%, strain rate −1.9/sec). No difference was present between segmental and global measurements of cardiac strain and strain rate, although basal and apical velocities were significantly different from global velocities for both right and left ventricles. In fetuses with heart disease, lower global cardiac strain appeared to correlate with clinical status, although there was no correlation with visual estimates of cardiac function or outcome. Conclusion: Measurement of global longitudinal cardiac strain and strain rate is possible in fetuses using VVI. Segmental measurements are not significantly different from global measurements; global measurements may be a useful tool to quantitate fetal cardiac function.     

术中超声心动图在心脏外科的应用价值

术中超声心动图包括经食道和心外膜超声心动图 ,在心脏外科体外循环前能完善诊断 ,有效降低围术期的并发症。本文概述该项技术在心脏外科手术中的应用价值。     

实时三维超声心动图在心脏肿瘤诊断中的应用

实时三维超声心动图(RT-3DE)是心脏超声发展的重大飞跃,可为心血管疾病的准确诊断提供更多的有用信息.二维超声心动图能够准确、直观地了解心室肿瘤的形态、大小、附着部位及活动度,RT-3DE能够显示肿瘤的整体形态和空间位置关系,较二维超声有更大的优势.现就RT-3DE在心脏肿瘤诊断中的应用作一综述.     

Utility of Combined Indexes of Electrocardiography and Echocardiography in the Diagnosis of Biopsy Proven Primary Cardiac Amyloidosis

Objective: Primary cardiac amyloidosis (CA) is associated with poor prognosis. However, the noninvasive diagnostic tools are limited. The aim of the study is to assess the utility of combined indexes of electrocardiography (ECG) and echocardiography (ECHO) in the diagnosis of primary CA. Methods: A total of 20 consecutive patients (7 men, mean age 50 ± 12 years) referred for endomyocardial biopsy (EMB) were included. Eleven of these patients (55%) confirmed primary CA, the rest of 9 patients were EMB negative and used for the control. Results: The voltage of S_V1+ R_V6 < 1.2 mV has a sensitivity of 91% and specificity of 89% for the identification of primary CA, yields the positive and negative predictive values of 91% and 89%, respectively. Among ECHO parameters, there were no significant differences between the 2 groups, except for left ventricular ejection fraction (47 ± 12% in primary CA vs 67 ± 11% in the control, P < 0.001). However, the combined indexes of ECG and ECHO parameters, including the ratio of R_I/LVPW as well as R_V5/LVPW and R_V6/LVPW, were significantly lower in the patients with primary CA than the control. The ratio of R_I/LVPW < 0.4 has the sensitivity of 91% and specificity of 100%, yields the positive and negative predictive values of 100% and 91%, respectively. The ratios of R_V5(6)/LVPW < 0.7 have the sensitivity of 91% and specificity of 89%, yield the positive and negative predictive values of 91% and 89%, respectively. Conclusion: Patients with clinically suspected primary CA, combined indexes of ECGs and ECHOs could be used as the noninvasive diagnostic tools. Ann Noninvasive Electrocardiol 2011;16(1):25–29     

Intraoperative Echocardiography and Minimally Invasive Cardiac Surgery

The term minimally invasive cardiac surgery encompasses a number of different techniques, each with its own rationale, origin, and development, but all focusing on limiting the physiologic trespass of cardiac surgery on the patient. In this article, we discuss the application of intraoperative echocardiography to three types of these procedures: Offpump coronary artery bypass graft (OPCABG) surgery, valvular surgery through limited thoracic incisions, and port-access heart surgery.     

超声评价心脏机械同步性的方法及进展

心力衰竭患者普遍存在不同程度的心室内或心室间的不同步化运动,超声心动图尤其是各种新技术在准确评估心脏机械不同步运动的部位、范围及程度方面均具有重大作用。现详细介绍了二维、M型及脉冲多普勒三种传统超声心动图技术和组织多普勒、二维应变、三维全容积和速度向量成像等新技术如何评价房室同步性、室间同步性以及左室内同步性。超声心动图在为心脏再同步化治疗(CRT)筛选合适的患者,预测和评价CRT疗效,CRT术后随访观察,AV和VV间期的优化等方面具有重要临床意义。     

Advances in Fetal Echocardiography: Early Imaging,Three/Four Dimensional Imaging,and Role of Fetal Echocardiography in Guiding Early Postnatal Management of Congenital Heart Disease

In this article, we review a number of topics that we believe reflect new and exciting aspects of fetal echocardiography. These new advances include early fetal cardiovascular imaging around 14 weeks, the utility of three/four dimensional imaging technology for the fetus, and finally the utility of fetal echocardiography for antenatal and perinatal care of congenital heart diseases to improve and optimize outcome. Finally, we briefly discussed future directions in fetal cardiac intervention.     

Fetal mouse imaging using echocardiography: a review of current technology

Advances in genetic research have led to the need for phenotypic analysis of small animal models. However, often these genetic alterations, especially when affecting the cardiovascular system, can result in fetal or perinatal death. Noninvasive ultrasound imaging is an ideal method for detecting and studying such congenital malformations, as it allows early recognition of abnormalities in the living fetus and the progression of disease can be followed in utero with longitudinal studies. Two platforms for fetal mouse echocardiography exist, the clinical systems with 15-MHz phased array transducers and research systems with 20-55-MHz mechanical transducers. The clinical ultrasound system has limited two-dimensional (2D) resolution (axial resolution of 440 microm), but the availability of color and spectral Doppler allows quick interrogations of blood flows, facilitating the detection of structural abnormalities. M-mode imaging further provides important functional data, although, the proper imaging planes are often difficult to obtain. In comparison, the research biomicroscope system has significantly improved 2D resolution (axial resolution of 28 microm). Spectral Doppler imaging is also available, but in the absence of color Doppler, imaging times are increased and the detection of flow abnormalities is more difficult. M-mode imaging is available and equivalent to the clinical ultrasound system. Overall, the research system, given its higher 2D resolution, is best suited for in-depth analysis of mouse fetal cardiovascular structure and function, while the clinical ultrasound systems, equipped with phase array transducers and color Doppler imaging, are ideal for high-throughput fetal cardiovascular screens.     

Tricuspid Atresia Associated with Truncus Arteriosus versus Aortopulmonary Window: Combining Fetal and Postnatal Echocardiography to Make the Diagnosis

The coincident occurrence of tricuspid atresia and aortopulmonary window (APW) is exceedingly rare, with one previous case reported in the literature. We present a patient with tricuspid atresia, pulmonary atresia, and APW. Postnatal echocardiograms demonstrated no visible pulmonary valve, and additional defects including a bicuspid aortic valve, right aortic arch and anomalous coronary arteries raised suspicion for tricuspid atresia with persistent truncus arteriosus. However, fetal echocardiography and direct visualization of the anatomy confirmed the alternate diagnosis. The patient underwent successful palliation consisting of APW repair, atrial septectomy and a 3.5 mm modified Blalock–Taussig shunt, followed by a bidirectional cavopulmonary connection.     

Three-Dimensional Myocardial Perfusion Maps by Contrast Echocardiography

We evaluated the clinical applicability of a system for three-dimensional (3-D) display of a perfusion map following myocardial contrast echocardiography (MCE). The system was used in 12 patients (9 males and 3 females, mean age 52 ± 10 years) undergoing interventional treatment of chronic total coronary occlusion. In each patient three standard apical views were acquired at baseline with sonicated Iopamidol^R injections into the left coronary artery (LCA) and into the right coronary artery (RCA). Following successful recanalization of the occluded artery MCE was repeated. The patients tolerated the procedure well. Acquisition of three standard apical views provided sufficient information for the reconstruction of 3-D perfusion maps containing the 16 standard left ventricular (LV) segments. Side-by-side display of the perfusion maps obtained following LCA and RCA echocontrast injections allowed us to classify the myocardial segments (192) into three groups: (1) those supplied by one major artery (124); (2) those supplied by collaterals from contralateral or both major arteries (58); and (3) segments supplied by none of the major arteries (10). Decreased opacification was observed in 50 segments of group 2. Following successful intervention we were able to visualize the redistribution of blood flow delivered to the LV myocardium by each major coronary artery in 3-D format. We conclude that this 3-D approach, which can easily be performed with currently available ultrasound equipment, allows an estimate of the contribution of each major coronary artery to LV perfusion before and after coronary angioplasty.     

实时三维超声心动图在心脏再同步化治疗中的应用研究进展

实时三维超声心动图是近年来超声成像领域内的一项新技术,可以从多方位显示心脏结构的立体关系,使临床医师能够采用无创的方法,方便准确的观察心脏的解剖结构和功能。在评价心脏机械收缩失同步、心脏再同步治疗患者筛选、指导起搏电极植入、起搏参数调控及术后随访中发挥着日益重要作用。     

Diagnosis of Contained Aortic Rupture by Transesophageal Echocardiography

Hematogenous seeding is the most common mechanism for the development of peripheral arterial infections. Echocardiography, and especially transesophageal echocardiography, has played an increasingly important role in the diagnosis of aortic pathology. Rupture of an aortic aneurysm is difficult to diagnose antemortem, and requires a high index of suspicion and a rapid diagnosis if surgery is to be beneficial. We present a case of a ruptured aortic aneurysm secondary to seeding from B. fragilis bacteremia suspected by transesophageal echocardiography and confirmed by surgical exploration. The two-dimensional echocardiographic and color flow Doppler findings are described and differentiated from those seen in an aortic dissection.     

Diagnosis of Tetralogy of Fallot and Its Variants in the Late First and Early Second Trimester: Details of Initial Assessment and Comparison with Later Fetal Diagnosis

Objective: We sought to evaluate the completeness of echocardiographic diagnosis of fetal tetralogy of Fallot (fTOF) at 12–17 weeks gestation, and compare assessment and clinical outcomes to diagnoses made at >17 weeks gestation. Methods: We identified all fTOF diagnoses made in our experience from 2003 to 2008. Referral indication, anatomic detail by echocardiography and pregnancy outcomes were compared between fetuses diagnosed at ≤17 weeks (Group I) and >17 weeks gestation (Group II). A 10‐point scoring tool was applied retrospectively to the echocardiograms at initial diagnosis (1 point each was ascribed to visualization of right ventricular outflow obstruction, pulmonary valve, pulmonary arteries including dimensions, pulmonary arterial flow, systemic and pulmonary venous anatomy, atrioventricular valves, ductus arteriosus, ductus flow, aortic arch morphology, sidedness and flow). Results: There were 10 pregnancies in Group I (12–17 weeks) and 25 in Group II (mean gestation at diagnosis 23.5 ± 5.7). The most common reason for referral was extracardiac pathology in Group I (80%) and suspected fetal heart disease on obstetric ultrasound in Group II (64%). Transabdominal imaging was adequate in about half of Group I studies. Mean anatomic diagnosis score in Group I was 6.1(range 2.5–9) and Group II was 8.4 (range 6.5–10). Elective pregnancy termination occurred in 80% in Group I and 33% in Group II. Conclusions: fTOF can be diagnosed in first and early second trimesters with detailed anatomic assessment possible in most. Referral indication and pregnancy outcome differ considerably between early and later prenatal diagnosis of fTOF.     

Large Mass in Left Atrium by Transesophageal Echocardiography: An Unusual Case of Cardiac Angiosarcoma Mimicking a Cystic Mass

Primary cardiac tumors are extremely rare. Among them, malignant tumors constitute approximately 15% of primary cardiac tumors. Angiosarcomas are the most frequent. They often appear as mural masses in the right atrium and completely replace the atrial wall and fill the entire cardiac chamber. We report an unusual case of angiosarcoma in a 75‐year‐old woman with a cystic appearance, located in the left atrium and causing critical mitral stenosis. (Echocardiography 2010;27:E137‐E138)     

Effect of Diltiazem on Cardiac Remodeling in Rats Assessed by Doppler Echocardiography and mRNA Expression

Summary. The purpose of this study was to examine the effect of diltiazem on cardiac dysfunction and the change in cardiac gene expression after myocardial infarction in rats. On the first day after myocardial infarction, rats were randomly assigned to a diltiazem treatment (Dil, n = 7) or an untreated group (MI, n = 8). We then performed Doppler-echocardiographic examinations on the rats and measured their hemodynamics at 4 weeks after myocardial infarction. Following these measurements, their cardiac mRNA was analyzed. Diltiazem decreased the mean aortic pressure and heart rate. Left ventricular end-diastolic pressure (LVEDP) and central venous pressure (CVP) increased to 18 ± 2 mmHg and 5 ± 1 mmHg (P < 0.01). Diltiazem reduced LVEDP to 14 ± 1 mmHg (P < 0.05), but it did not change CVP. The weight of the right ventricle in MI was significantly larger than in the control rats (control, n = 7, 0.46 ± 0.02 g/kg vs. MI, 0.81 ± 0.06 g/kg; P < 0.01). The left ventricular end-diastolic dimension (LVDd) in MI increased to 8.8 ± 0.3 mm (P < 0.01, control, 6.1 ± 0.3 mm). Diltiazem prevented an increase in the weight of the right ventricle (0.69 ± 0.03 g/kg, P < 0.05) and LVDd (7.7 ±6 0.2 mm, P < 0.05 to MI). The rats within MI showed systolic dysfunction, defined by a decreased ejection fraction (control, 67 ± 2% vs. MI, 36 ± 3%, P < 0.01), and diastolic dysfunction, defined by the E-wave deceleration rate (control, 13.4 ± 1.6 m/s² vs. MI, 30.4 ± 3.4 m/s² P < 0.01). Diltiazem significantly prevented systolic and diastolic dysfunction. The increases in -MHC, ANP, and collagen type I and III mRNAs in the noninfarcted left ventricle and right ventricle were significantly suppressed by treatment with diltiazem. -Skeletal actin increased in MI, and -skeletal actin was more increased with Dil. In conclusion, diltiazem prevents cardiac dysfunction and morphological change due to left ventricular remodeling after experimental myocardial infarction.