超声心动图评价成人房间隔缺损封堵术后心脏结构和功能的变化

目的探讨超声心动图评价成人房间隔缺损(atrial septal defects,ASD)介入封堵术后心脏形态和功能变化。方法经超声心动图和心电图检查确诊为ASD并成功施行ASD封堵术的患者74例,年龄(35.63±12.74)岁,ASD直径为(16.29±5.11)mm。于封堵器堵闭术后24h、1个月、3个月、6个月和12个月进行经胸超声心动图追踪测量主动脉内径、左心室舒张末内径、左心室收缩末内径和右心室前后径,肺动脉内径和肺动脉瓣血流速度,右心房和右心室的上下径、主动脉瓣口血流速度、二尖瓣口血流速度、三尖瓣口血流速度和左心室射血分数,同时测量封堵器的直径和长度,并进行统计学分析。结果术后24h与术前相比,右心房内径、右心室内径、肺动脉内径、三尖瓣口血流速度和肺动脉瓣口血流速度均显著减少(P0.01);左心房内径、左心室内径、主动脉内径、二尖瓣口血流速度和主动脉瓣口血流速度均显著增加(P0.05);左心室射血分数无明显变化。房室大小和血流速度在术后24h内变化明显,在术后1个月后的随访中逐渐趋于稳定。结论封堵器介入封堵ASD,既纠正了解剖畸形,又改善了左心和右心系统的几何结构。     

Successful closure of transcatheter aortic valve replacement-induced Gerbode defect with valve-in-valve technique: A case report

We present the first documented case of a successful closure of a transcatheter aortic valve replacement (TAVR)-induced Gerbode defect using a valve-in-valve approach. A 90-year-old female with severe aortic stenosis underwent TAVR. Following post-dilatation, the patient experienced hemodynamic deterioration and collapse due to tamponade and sub-annular rupture leading to hemodynamic deterioration and the development of a Gerbode defect with communication between the left ventricle and right atrium. Hemodynamic stabilization was achieved through pericardiocentesis, followed by the low implantation of a second valve, effectively sealing the rupture. This case showcases a valuable alternative for managing rare challenging complications during TAVR procedures.     

Two-dimensional color doppler echocardiographic imaging of a Gerbode defect: a case report

A Gerbode defect is a ventricular septal defect that communicates directly between the left ventricle and the right atrium. The pathology may be due to a congenital defect, can result from trauma, or can occur after endocarditis or aortic valve replacement. We report the case of a 20-year-old man who has a defect between the left ventricle and the right atrium (Gerbode defect) that was diagnosed with two-dimensional color Doppler echocardiography.     

超声心动图技术评价人工瓣机能的临床研究

目的 应用经胸(TTE)和经食管超声心动图(TEE)评价二尖瓣(MV)或/和主动脉瓣(AV)置换术后人工机械瓣机能。方法 对201例MV或/和AV置换者频谱测量血流峰值速度和跨瓣压差,评估人工瓣反流及瓣周漏程度;二维超声观察人工瓣,测量手术前后左心房、左心室内径和左心室射血分数(LVEF)。结果 (1)相同瓣位StJude、G-K、On-x人工瓣前向峰值血流速度(Vmax)和跨瓣压差(△P)之间无显著差异。(2)164枚人工MV出现0级反流131例(79.88%),I级反流29例(17.68%);Ⅱ级2例(1.22%);瓣周漏2例(1.22%)。81枚人工AV69例(85.18%)无反流,12例(14.82%)轻度反流。(3)术后左心房、左心室较术前明显缩小,LVEF较术前减低。结论TTE对人工瓣活动、瓣周异常和血流动力学的评判简便易行,TEE具有进一步评价病变部位、程度及术中即刻评价手术效果的优点。     

Blood Cyst of the Mitral Valve: A Rare Cause of Stroke

Intracardiac blood cysts are thin-walled cysts, lined by flattened, cobblestone-shaped epithelium, and filled with nonorganized blood. During autopsy, they are found on cardiac valves in approximately 50% of infants below the age of 2 months and are rarely found after the age of 2 years. We report a rare case of blood cyst attached to the mitral valve and a possible cause of an embolic stroke.     

Iatrogenic communications between aortic root and right ventricle/left atrium after transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) has emerged as an alternative, less invasive treatment option for patients with severe symptomatic aortic stenosis, who are high‐risk for conventional surgical aortic valve replacement, due to co‐morbidities. In addition to a 30‐day 10% mortality risk there is a recognized range of complications, which commonly relate to vascular access trauma, paravalvular aortic regurgitation, and cerebrovascular events. In the following case reports, we discuss two previously unreported complications of TAVR: (i) an iatrogenic communication between the aortic root and the right ventricle and (ii) an iatrogenic communication between the aortic root and the left atrium. Informed written consent was obtained from both paztients. © 2013 Wiley Periodicals, Inc.     

Transcatheter closure of acquired left ventricle to right atrium shunts

We describe transcatheter closure of an acquired Gerbode defect (left ventricle to right atrium shunt) in four patients, ranging in age from 8 to 75 years. All of them had undergone previous surgery (VSD closure in 3, aortic valve replacement in 1), and either had persistent symptoms of heart failure, or developed new symptoms several months or years later. The diagnosis was made by one of several imaging modalities (transthoracic or transesophageal echocardiography, or MRI), and confirmed at cardiac catheterization. Device closure using a variety of devices was successful in all, with resolution of symptoms. One patient developed complete heart block, requiring permanent pacemaker implantation. Transcatheter closure is effective, and may replace surgery in the management of these defects. © 2013 Wiley Periodicals, Inc.     

Suicide left ventricle following protamine: A case report

A patient with severe aortic stenosis and left ventricular hypertrophy underwent a transcatheter aortic valve replacement. The patient's blood pressure significantly dropped after protamine administration. A diagnosis of suicide left ventricle post-valve replacement was made. The diagnosis and management of the protamine reaction are detailed. This case highlights the need to slowly infuse protamine sulfate and monitor for adverse events.     

Coronary-cameral fistula in association with intracardiac tumour and aortic stenosis in an adult

We present a patient with the unexpected association of left ventricular tumor, a fistula between the right coronary and the right atrium, and senile valvar aortic stenosis. He had anginal complaints. Doppler echocardiography revealed moderate aortic stenosis with mild aortic and moderate mitral regurgitation. A tumour was detected in the left ventricle. Selective coronary angiography disclosed normal anatomy with a fistula originating from the proximal right coronary artery and draining into the right atrium. He refused operative treatment and is still alive, 1 year after the diagnosis was made, without complications.     

Successful transcatheter treatment for very late migration of a transcatheter aortic valve into the left ventricular outflow tract

Although rare, embolization or migration of transcatheter aortic valves into the left ventricle has been described. We report a case of very late migration of an Edwards Sapien XT (Edwards Lifescience Corporation, Irvine, California) valve that was placed 4 years prior to the development of recurrent severe aortic stenosis with the transcatheter heart valve situated below the native stenotic aortic valve in the left ventricular outflow tract. The management options in this scenario, and outline how they successfully treated this challenging case with transfemoral TAV-in-TAV have also been discussed.     

Value of intraoperative transesophageal echocardiography in preventing serious complications during valvular surgery. A report of four cases

The value of routine transesophageal echocardiography (TEE) was confirmed by the detection of rare and potentially serious complications in four of 136 patients (2.9%) undergoing valvular surgery. In case 1, one leaflet of a St. Jude Medical (SJM) valve implanted in the mitral position was stuck in the closed position; normal valve function was restored by 90 degrees rotation of the prosthesis. In case 2, moderate regurgitation was observed after mitral valve replacement with a Carpentier-Edwards pericardial bioprosthesis. The mitral valve was replaced with a SJM valve; regurgitation was proved due to a suture loop jamming. In case 3, perivalvular leakage was detected after aortic valve replacement for infective endocarditis; an additional suture stopped the leakage. In case 4, a foreign body was observed in the left atrium after aortic valve replacement for calcified aortic stenosis. The left atrium was re-opened, and a free-floating portion of the calcified native aortic valve was identified and removed. Routine intraoperative TEE in valve surgery permits the identification and management of potentially serious complications before discontinuing cardiopulmonary bypass.     

Ultrasound in the diagnosis of congenital heart disease

In addition to recording the motion of the mitral, tricuspid, aortic, and pulmonic valves, echocardiography can identify right and left ventricular cavities and the interventricular septum. Disorders such as atrial-septal defect, valvular and subvalvular aortic stenosis, pulmonic stenosis, Ebstein's anomaly of the tricuspid valve, and the hypoplastic left-heart syndrome can readily be evaluated by echocardiography. In tetralogy of Fallot and truncus arteriosus, discontinuity between the anterior aortic wall and septum with overriding aorta has been demonstrated. Doubleoutlet right ventricle is associated with posterior aortic wall and mitral valve discontinuity. In disorders such as single ventricle, tricuspid atresia, and endocardial cushion defect with common A-V canal, echocardiographic demonstration of the absence of the interventricular septum has provided the clinician with valuable information.Newer techniques such as compound-B ultrasonography, which produces a two-dimensional cross-sectional image of intracardiac structures, and multiscan echocardiography will enhance the use of conventional echocardiography by providing a more accurate anatomic display of cardiac chambers and outflow vessels.     

A case of left atrial ball thrombus observed in a patient with combined valvular heart disease, accompanying anomalous coronary venous run

A 53-year woman, who had been under observation for combined valvular heart disease, was admitted to our hospital for further examination of embolic episodes to brain and kidney. Echocardiographic examination showed the evidence of free-moving ball thrombus in the left atrium, and emergent cardiac catheterization following the echocardiography confirmed the diagnosis of it as well as mitral stenosis, aortic regurgitation with stenosis, and tricuspid regurgitation. In addition, coronary angiography disclosed the anomalous coronary venous run. With these findings, the cause of embolic episodes was found to be due to the thrombus in the left atrium. In the surgery performed a ball thrombus of 40 x 35 x 36 mm and a mural thrombus of 15 x 35 x 20 mm in size in the left atrium were detected and removed, and both mitral and aortic valves were replaced to artificial ones. She had a good hospital course after the surgery and discharged without any complication. In this report, we discussed a case of left atrial thrombus observed in a combined valvular heart disease, with 29 literatures reported in our country.     

Aortenstenose

Aortic valve stenosis is the most frequent reason for prosthetic valve replacement in adults. Its incidence increases with age. Development of the most frequent form, degenerative-calcific aortic stenosis, is related to atherosclerotic risk factors. The narrowing of the aortic valve orifice leads to creation of a systolic pressure drop, the gradient, between left ventricle and ascending aorta. The pressure overload from aortic stenosis causes concentric left ventricular hypertrophy and later heart failure. Typical symptoms of severe aortic stenosis include dyspnea, angina, and dizziness or syncope. On auscultation, a loud systolic murmur over the base of the heart is apparent, which is transmitted to the carotids. The ECG often shows left ventricular hypertrophy. The most important diagnostic technique is echocardiography, which allows to measure the gradient and to calculate the orifice area, which determine the degree of severity. The development of symptoms or impaired left ventricular function in severe aortic stenosis should prompt surgical treatment by valve replacement. Truly asymptomatic patients with preserved left ventricular function should be followed conservatively.     

Aortic valve stenosis

Aortic valve stenosis is the most frequent reason for prosthetic valve replacement in adults. Its incidence increases with age. Development of the most frequent form, degenerative-calcific aortic stenosis, is related to atherosclerotic risk factors. The narrowing of the aortic valve orifice leads to creation of a systolic pressure drop, the gradient, between left ventricle and ascending aorta. The pressure overload from aortic stenosis causes concentric left ventricular hypertrophy and later heart failure. Typical symptoms of severe aortic stenosis include dyspnea, angina, and dizziness or syncope. On auscultation, a loud systolic murmur over the base of the heart is apparent, which is transmitted to the carotids. The ECG often shows left ventricular hypertrophy. The most important diagnostic technique is echocardiography, which allows to measure the gradient and to calculate the orifice area, which determine the degree of severity. The development of symptoms or impaired left ventricular function in severe aortic stenosis should prompt surgical treatment by valve replacement. Truly asymptomatic patients with preserved left ventricular function should be followed conservatively.     

Apico-Aortic Conduit for severe aortic stenosis: Technique,applications, and systematic review

Patients referred for aortic valve replacement are often elderly and may have increased surgical risk associated with ascending aortic calcification, left ventricular dysfunction, presence of coronary artery disease, previous surgery, and/or presence of several co-morbidities. Some of these patients may not be considered candidates for conventional surgery because of their high risk profile. While transcatheter aortic valve replacement constitutes a widely accepted alternative, some patients may not be eligible for this modality due to anatomic factors. Apico-Aortic Conduit (AAC) insertion (aortic valve bypass surgery) constitutes a possible option in those patients. Apico-Aortic Conduit is not a new technique, as it has been used for decades in both pediatric and adult populations. However, there is a resurging interest in this technique due to the expanding scope of elderly patients being considered for the treatment of aortic stenosis. Herein, we describe our surgical technique and provide a systematic review of recent publications on AAC insertion, reporting that there is continued use and several modifications of this technique, such as performing it through a small thoracotomy without the use of the cardiopulmonary bypass.Abbreviations: AAC, Apico Aortic Conduit; AS, aortic stenosis; AVR, aortic valve replacement; BSA, body surface area; CABG, coronary artery bypass grafting surgery; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CPB, cardiopulmonary bypass; DHCA, deep hypothermic circulatory arrest; FEM-FEM, femoro-femoral; ITA, internal thoracic artery; LITA, left internal thoracic artery; LVH, left ventricular hypertrophy; LVOT, left ventricle outflow tract; NYHA, New York Heart Association; MDCT, multidetector-computerized tomography; MVR, mitral valve replacement; OPCAB, off pump coronary artery bypass; PH, pulmonary hypertension; RITA, right internal thoracic artery; TEE, transesophageal echocardiography; TAVI, transcatheter aortic valve implantation     

Evaluation of secondary tricuspid regurgitation by intraoperative epicardial pulsed Doppler echocardiography

Since 1985, we have evaluated secondary tricuspid regurgitation associated with acquired mitral valve disease in patients undergoing open mitral surgery by intraoperative epicardial two-dimensional and pulsed Doppler echocardiography. We found intraoperative pulsed Doppler echocardiography to be a sensitive, safe technique allowing surgeons to evaluate the severity of tricuspid regurgitation intraoperatively, even in critically ill patients who cannot afford preoperative cardiac catheterization. To assess the severity of tricuspid regurgitation intraoperatively, the transducer was placed directly on the right atrium. The ultrasound beam was transmitted into the right atrium at right angles to the tricuspid valve orifice to record intraoperative four-chamber two-dimensional echocardiograms, which were used to detect the sites of eight sample volumes, one in the right ventricle and seven in the right atrium, for pulsed Doppler echocardiography. The pulsed Doppler signals were recorded in each sample volume before and after cardiac procedures. The pansystolic abnormal signals lasting from tricuspid valve closure to the subsequent opening and consisting of components moving away from the tricuspid valve were interpreted as tricuspid regurgitant flows. Without operative correction of the tricuspid valve, secondary tricuspid regurgitation can resolve following mitral valve surgery alone. However, to our knowledge, there are no published reports of objective findings of intraoperative changes of secondary tricuspid regurgitation. Here we present the unique intraoperative pulsed Doppler echocardiographic features of tricuspid regurgitation before and after cardiac procedures. A 30-year-old woman with preoperative diagnosis of aortic regurgitation, mitral stenosis and severe tricuspid regurgitation underwent aortic and mitral valve replacement. The intraoperative pulsed Doppler echocardiograms recorded after pericardiotomy and before cannulation of the heart showed tricuspid regurgitant flow signal in all of the seven sample volumes in the right atrium, which was interpreted as severe tricuspid regurgitation. After surgical procedures, no regurgitant flow from the tricuspid orifice to the right atrium was detected in the eight sample volumes. This suggested that preoperative secondary tricuspid regurgitation improves without operative procedures for the tricuspid valve. All intraoperative echocardiographic procedures were performed within 5 min, and no arrhythmias or other complications related to this technique were noted. Epicardial pulsed Doppler echocardiography is helpful in assessing tricuspid valve function of patients undergoing mitral valve surgery bef     

Transcatheter neoaortic valve replacement utilizing the melody valve in hypoplastic left heart syndrome

Percutaneous transcatheter pulmonary valve replacement with the Melody Valve is fast becoming an important adjunct in the treatment of older children and adults with failing right ventricular outflow tract conduits. Recently, the Melody Valve has also been successfully implanted in the tricuspid, mitral, and aortic positions, typically within a failing bioprosthetic valve. We present a patient who underwent Fontan palliation for hypoplastic left heart syndrome variant and subsequently developed severe neoaortic regurgitation, which was successfully treated with a transcatheter neoaortic valve replacement. To our knowledge, this is the first successful use of the Melody Valve in the neoaortic position in a patient with single‐ventricle physiology. Successful relief of neoaortic valve regurgitation using replacement with a transcatheter valve may allow avoidance of additional surgery, increase functional longevity of single‐ventricle palliation, and postpone the need for orthotopic heart transplantation. © 2014 Wiley Periodicals, Inc.     

Absent left-sided atrioventricular connexion, with right atrium connected to left ventricle: prospective diagnosis in infancy, and outcome.

Prospective echocardiographic diagnosis of absence of the left atrioventricular connexion, with the right atrium connected to a morphologic left ventricle through a bileaflet morphologically mitral valve, was made in six infants. The rudimentary right ventricle was left-sided in all patients, and separated from the left atrium by sulcus tissue. The ventriculoarterial connexions were discordant. Associated defects included subpulmonary stenosis (2 patients), pulmonary atresia (1 patient), and a patent duct (4 patients). All patients developed early left atrial hypertension due to a restrictive interatrial septum, and required transcatheter septostomy (5 patients), or surgical septectomy (3 patients). One patient who had a severely restrictive ventricular septal defect died following cardiac catheterization. In three others the ventricular septal defect has become progressively restrictive on serial catheterization. Successful intermediate term palliation has been performed in two patients using a bidirectional Glenn anastomosis, together with enlargement of the ventricular septal defect and a Damus-Kay-Stansel procedure in one. It is possible to distinguish this malformation from "mitral atresia" using cross-sectional echocardiography. The long-term outlook is influenced by early relief of left atrial hypertension. Balloon atrial septostomy alone is usually inadequate, and either blade septostomy or surgical septectomy are required. Serial cardiac catheterization is mandatory for planning definitive palliation.     

Shock,Thrombus, TAVR: A Challenging TAVR With Large Left-Ventricular Thrombus

A 50-year-old man presented in cardiogenic shock. Echocardiogram showed ejection fraction (EF) 22%, apical thrombus, and severe bicuspid aortic stenosis. Transcatheter aortic valve replacement (TAVR) was recommended, given his high surgical risk. Urgent TAVR was performed without complication, using transcatheter cerebral embolic protection and intracardiac echocardiography (ICE) for left-ventricular wire placement. The patient was discharged on warfarin, and follow-up echocardiogram showed no apical thrombus, EF 55%, and well-functioning bioprosthesis. This case shows a good TAVR outcome in bicuspid aortic stenosis despite apical thrombus and poor EF. Cerebral embolic protection and ICE can minimize risk of stroke.