Repair of left ventricular aneurysm during off-pump coronary artery bypass surgery

Background Acute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejection fraction was 26%±9%. The mean left ventricular, end diastolic diameter was (57.5±7.1) mm. The ventricular preoperative and postoperative performances were compared. χ2 test and Student’s t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.Results Hospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P<0.001). The mean left ventricular, end diastolic diameter decreased significantly (P<0.001). Conclusions Surgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.     

速度向量成像技术评价正常人左室舒张功能及其参考值范围

目的探讨应用速度向量成像技术(VVI)评价正常人的左室舒张功能并确定其正常参考值范围。方法结合超声、NT-BNP、临床症状等指标筛选健康人97名,使用西门子公司的Acuson Sequoia C512超声心动仪,采用VVI测量静息状态下左室二尖瓣环水平6个壁:室间隔、侧壁、前壁、下壁、前间隔、后壁的心肌舒张早期速度(E),脱机后进入VVI工作站操作界面采用盲法对图像进行VVI分析并计算平均值Em,测出E/Em,对正常人群的参考值范围给出参考界定。结果 97例正常人E/Em的参考值范围(单侧界限取95%界限)为(1,22.935);男性、女性E/Em参考值范围分别为(1,22.300)和(1,24.766);50岁以下男性、女性E/Em参考值范围分别为(1,22.413)和(1,24.314);50岁以上男性、女性E/Em参考值范围分别为(1,15.410)和(1,24.870)。结论 VVI作为一种新的超声技术,是无创性评价左室舒张功能的好方法,为临床准确评价左室舒张功能提供了一种可靠手段。     

定量组织速度成像评价动脉粥样硬化家兔左室舒张功能的实验研究

目的:应用超声定量组织速度显像(QTVI)技术评价动脉粥样硬化家兔左室舒张功能。方法:24只雄性日本大耳白兔随机分为对照组8只和实验组16只,实验组以高脂饲料饲养建立动物模型。实验组在高脂饲料饲养的8、12周测定二尖瓣环舒张早期平均峰值速度(Em)及舒张晚期平均峰值速度(Am),将Em/Am的比值进行显著性比较。结果:实验组在高脂饲料饲养的12周,Em/Am与对照组相比差异具有显著性(P<0.01)。结论:QTVI技术可以实时、客观地评价动脉粥样硬化家兔的左室功能。     

Smoking and hyperlipidemia are important risk factors for coronary artery spasm

Objective To investigate the role of coronary artery spasm in the etiology of chest pain lacking significant coronary stenosis and to identify the clinical risk factors related to coronary artery spasm.Methods Two hundred and seventy five patients with chest pain, but without significant coronary artery stenosis underwent the intracoronary acetylcholine test. Coronary artery spasm was diagnosed while coronary artery stenosis increased to 90% and was accompanied by the usual chest pain with or without ischemic changes on electrocardiogram. Logistic regression was employed to investigate the relationships between coronary artery spasm and sex, age, hypertension, diabetes mellitus, smoking,hyperlipidemia and results of electrocardiographic treadmill stress test. Left ventricular ejection fraction and end diastolic pressure were compared between spasm group and non-spasm group.Results Coronary artery spasm was detected in 103 out of 271 patients, a rate of 38%. Logistic regression analysis showed that smoking and hyperlipidemia increased the relative risk of coronary artery spasm 4.2 times and 2.3 times, respectively. There was a significantly negative relationship between diabetes mellitus and coronary artery spasm. Furthermore, there was no coronary artery spasm detected in left ventricular ejection fraction and end diastolic pressure.Conclusions Coronary artery spasm was one of the important etiological factors for patients with chest pain but no coronary artery stenosis. Smoking and hyperlipidemia were the main clinical risk factors for coronarv arterv spasm.     

Detection of Left Ventricular Regional Relaxation Abnormalities in Patients with Hypertrophic Cardiomyopathy by Quantitative Tissue Velocity Imaging

To assess the left ventricular regional relaxation abnormalities in patients with hypertrophic cardiomyopathy (HCM) by quantitative tissue velocity imaging (QTVI), Doppler eehocar-diography and QTVI were performed in HCM (n=10) and healthy subjects (n=11) at apical long-axis, two-chamber and four-chamber views. Regional early diastolic velocity (rVe) and regional at-rial contraction (rVa) were measured at each segment of ventrieular middle, basal and annular levels. Mean rVe and mean rVa at three levels as well as mean rVe/rVa ratio were calculated. Our results showed that transmitral inflow peak velocities during early diastole (E) and atrial contraction(A) were also measured and E/A ratio was calculated. The rVe of all left ventrieular segments in HCM were lower than those in healthy subjects (P＜0.05), but compared with healthy subjects majority of rVa in HCM were not different except inferior wall and anterior wall. E between HCM and healthy subjects was different (P=0. 036), while mean rVe between them was significantly different (P＜0. 0001 ). Mean rVa and mean rVe/rVa of three levels were lower in HCM than in healthy subjects (P＜0.05), but there were no differences in A and E/A between them (P=0.22,P=0. 101). Left ventricular regional myocardial relaxation is reduced in HCM. Transmitral inflow E and A are influenced by preload, relaxation of myocardium and atrial contraction, etc. , while rVe and rVa reflect myocardial relaxation function independently. QTVI is more sensitive and more accurate than conventional Doppler imaging for characterizingregional diastolic properties in HCM.     

Evaluation of the asynchronization and function of the left ventricle in patients with chronic pulmonary hypertension by velocity vector imaging

Background Pulmonary hypertension （PH） is a set of pathophysiological syndromes characterized by increased pulmonary artery pressure and pulmonary vascular resistance,resulting in increased right ventricular afterload.The left and right ventricles interact through hemodynamics.What impact will PH have on synchronization and function of the left ventricle （LV）？ The aim of this study was to evaluate the synchronization of the left ventricular wall motion and left ventricular function in patients with varying degrees of PH using velocity vector imaging （Wl） technology.Methods Sixty patients with chronic PH served as the experimental group,and 20 healthy volunteers served as the control group.According to the different degrees of pulmonary artery systolic pressure,the experimental group was divided into three groups：mild,moderate,and severe PH groups.The time to peak systolic longitudinal velocity （Tvl）,the peak systolic longitudinal velocity （Vsl）,the peak diastolic longitudinal velocity （Vel）,the peak systolic longitudinal strain （SI）,and strain rate （SRI） in 18 segments were measured in each group.Results TvI in the control group and each group with PH was reduced from basal to apical segment,and in control group Tvl in various segments of the same wall and in different walls showed no significant difference （P ＞0.05）.With increase in pulmonary artery pressure,Tvl values measured showed an increasing trend in groups with PH.In groups with PH,Vsl and Vel of each wall were reduced sequentially from basal to apical segments,showing gradient change; Vsl and Vel values measured showed a decreasing trend with increase in pulmonary artery pressure,in which the differences of Vel values measured in the control group and the mild PH group were statistically significant （P ＜0.01）,and the differences between other groups were statistically significant （P ＜0.01）.In groups with PH,SI and SRI in basal segment and the middle segment of each wall were decreased; the difference between groups was statistically significant （P ＜0.01）.Conclusions Asynchronization of the LV and decreased left ventricular function were present in patients with chronic PH;WI technology can accurately evaluate left ventricular function in patients with PH,and indicators such as Tvl,Vsl,and Vel are valuable.     

Value of Quantitative Tissue Velocity Imaging in the Detection of Regional Myocardial Function in Dogs with Acute Subendocardial Ischemia

This study evaluated the application of quantitative tissue velocity imaging （QTVI） in assessing regional myocardial systolic and diastolic functions in dogs with acute subendocardial ischemia. Animal models of subendocardial ischemia were established by injecting microspheres （about 300 μm in diameter） into the proximal end of left circumflex coronary artery in 11 hybrid dogs through cannulation. Before and after embolization, two-dimensional echocardiography, QTVI and real-time myocardial contrast echocardiography （RT-MCE） via intravenous infusion of self-made microbubbles,were performed, respectively. The systolic segmental wall thickening and subendocardial myocardial longitudinal velocities of risk segments before and after embolization were compared by using paired t analysis. The regional myocardial video intensity versus contrast time could be fitted to an exponential function： y=A·（1-exp-β·t）, in which the product of A and β provides a measure of myocardial blood flow. RT-MCE showed that subendocardial normalized A·β was decreased markedly from 0.99±0.19 to 0.35±0.11 （P〈0.05） in 28 left ventricular （LV） myocardial segments after embolization, including 6 basal and 9 middle segments of lateral wall （LW）, 8 middle segments of posterior wall （PW） and 5 middle segments of inferior wall （IW）. However, there was no statistically significant difference in subepicardial layer before and after embolization. Accordingly, the ratio of A·β of subendocardial myocardium to subepicardial myocardium in these segments was significantly decreased from 1.10±0.10 to 0.31±0.07 （P〈0.05）. Although the systolic wall thickening did not change 5 min after the embolization in these ischemic segments （29%±3% vs 31%±5%, P〉0.05）, the longitudinal peak systolic velocities （Vs） and early-diastolic peak velocities （Ve） recorded by QTVI were declined significantly （P〈0.05）. Moreover, the subendocardial velocity curves during isovolumic relaxation predominant     

Anomalous origin of left coronary artery from pulmonary artery. Successful correction for a 7-year-old patient.

A 7-year-old girl with an anomalous origin of the left coronary artery from the pulmonary artery restored connection of the left coronary artery to the ascending aorta by aortocoronary bypass graft. Aortocoronary bypass grafting was performed with a vascular prosthesis. Postoperative angiography showed a patent left coronary artery without narrowing or kinking. Clinical improvement was rapid and the left ventricular function recovered completely.     

ASSESSMENT OF DIASTOLIC FUNCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY BY DOPPLER TISSUE IMAGING

Objective To determine the clinical application of pulsed Doppler tissue imaging in assessing the left ventricular diastolic function and in discriminating between normal subjects and patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction. Methods We measured the peak diastolic velocities of mitral annulus in 81 patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction and 50 normal volunteers by Doppler tissue imaging using the apical window at 2-chamber and long apical views, respectively. The myocardial velocities were determined with use of variance F statistical analysis. Results Early diastolic myocardial velocities ofmitral annulus were higher in normal subjects than in patients with hypertrophic cardiomyopathy with either delayed relaxation, pseudonormal filling, or restrictive filling. However, peak myocardial velocities of mitral annulus during atrial contraction were similar in normal subjects and patients with hypertrophic cardiomyopathy. Conclusion Doppler tissue imaging can directly reflect upon left diastolic ventricular function. Early phase of diastole was the best discriminator between control subjects and patients with hypertrophic cardiomyopathy.     

组织多普勒成像定量评价左室舒张功能

目的 应用组织多普勒成像技术(DTI)与左室舒张末压(LVEDP)对比评价左室舒张功能,探讨DTI评价左室舒张功能的临床价值.方法 选取33名患者,分为左室肥厚组(LVH)与非左室肥厚组(non-LVH),另选取15名健康人作为对照组,分别行超声多普勒及DTI检查,多普勒超声测量二尖瓣口舒张早期充盈速度(E)和舒张晚期充盈速度(A)及E/A,DTI模式测量二尖瓣环舒张早期运动速度(Ve)、舒张晚期运动速度(Va)和Ve/Va,以及用猪尾导管直接测量LVEDP.结果 实验组Ve/Va和E/A均比对照组显著减小(P<0.05),且LVH组Ve/Va比non-LVH组减小更为显著(P<0.05),而LVH组E/A与non-LVH组相比差异无显著性(P>0.05).LVEDP与Ve/Va、E/A呈负相关(r分别为-0.92和-0.79,P<0.05),室间隔厚度(IVSd)与ve/Va、E/A呈负相关(r分别为-0.67和-0.49,P<0.05),Ve/Va与LVEDP的相关性高于E/A与LVEDP的相关性.结论 DTI可作为评价左室舒张功能的可靠方法.     

斑点追踪显像技术与实时三平面定量组织速度成像技术评价高血压患者左室舒张功能

目的探讨斑点追踪显像(STI)技术和实时三平面(RT-3PE)定量组织速度成像(QTVI)技术评价高血压患者左室舒张功能的应用价值。方法收集32例高血压病患者(高血压病组)和40例正常人(正常组)的临床资料。应用STI技术获得左室6个壁基底段、中间段、心尖段的舒张早期峰值应变率(Sre)、舒张晚期峰值应变率(Sra),并分别计算平均峰值应变率(mSre、mSra)及mSre/mSra;用RT-3PE QTVI技术测得左室6个壁基底段、中间段的舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va),并计算平均组织速度(mVe、mVa)以及mVe/mVa,进行分析比较。结果与正常组比较,高血压病组的Ve、Sre明显降低,Va及大部分节段Sra升高,差异有统计学意义(P<0.05),mVe/mVa、mSre/mSra较正常组显著降低,而mSra升高,差异有统计学意义(P<0.05)。结论 RT-3PE QTVI技术和STI技术能准确地测量高血压病患者舒张期左室壁运动速度及左室心肌应变率,为无创检测高血压病患者左室舒张功能提供了新方法。     

定量组织速度成像及组织追踪成像技术与MRI检查评价急性心肌梗死犬左室壁节段性运动异常的对照研究

目的:应用定量组织速度成像(QTVI)技术、组织追踪成像(TTI)技术及MRI评价犬急性心肌梗死后左室壁节段性运动异常,探讨左室局域梗死心肌的运动幅度及舒缩功能变化。方法:利用QTVI及TTI技术对8只急性心肌梗死犬冠脉结扎前、后2h扫查心尖左室长轴、心尖二腔、心尖四腔切面,将取样容积分别置于左心室基底部(Bas)、二尖瓣环水平(Mv)、中部乳头肌水平(Mid)及心尖部心内膜下(AP),同步获取上述水平各取样点在左室前壁、后壁、侧壁下壁、后室间隔及前室间隔的心肌沿长轴方向运动组织速度曲线和位移曲线,观察各节段收缩期的运动速度及位移,记录各取样点收缩期峰值速度(Vs)、收缩期峰值位移(D)及舒张早期速度峰值(Ve)变化,并对心肌梗死犬进行MRI检测,观察梗死节段心肌室壁厚度及运动幅度变化情况。将两种影像学检测结果进行对比研究。结果:冠脉结扎后急性心肌梗死犬受累节段纵向上心肌收缩期峰值速度(Vs)、收缩期峰值位移(D)均较结扎前减低(P<0.05或P<0.01),舒张早期峰值速度减低,Ve丧失正常时由心底到心尖逐渐减低的规律。MRI结果显示,广泛左心室前壁、前间壁及部分侧壁运动减弱且厚度变薄。运动减弱及心肌厚度变薄区域与左前降支供血区域一致。结论:QTVI及TT能敏感、直观、定量评价左室局域梗死心肌节段性运动情况的及舒张、收缩功能,对急性心肌梗死的早期诊断具有重要意义,并与MRI所显示梗死节段具有较好的一致性。     

定量组织速度成像用于左室舒张功能的评价

目的 应用定量组织速度成像（QTVI）测定二尖瓣环运动速度评价高血压病患者左室舒张功能。方法 应用定量组织速度成像测定30例正常人和60例高血压病患者的二尖瓣环舒张早期峰值速度（Ve）、左房收缩期峰值速度（Va），计算Ve／Va比值；并用脉冲多普勒测定二尖瓣口舒张早期峰值血流速度E峰、舒张晚期峰值血流速度A峰，计算E／A值。结果 正常组舒张早期峰值速度（E）〉左房收缩期峰值速度（A），E／A〉1；二尖瓣环舒张早期峰值速度（Ve）〉左房收缩期峰值速度（Va），Ve／Va〉1，高血压病人组二尖瓣口血流频谱及二尖瓣环运动组织速度成像测值差异有显著性，高血压组中二尖瓣环运动速度Ve／Va与二尖瓣血流频谱V／A差异无显著性。但在检出病例中QTVI明显优于血流频谱。结论 应用定量组织速度成像测定二尖瓣口运动速度能较准确估计高血压病患者左室舒张功能。     

速度矢量成像检测成人隐匿性自身免疫性糖尿病亚临床左室功能不全

目的:探讨速度矢量显像(VVI)评价亚临床状态的成人隐匿性自身免疫性糖尿病(LADA)患者左室心肌长轴节段收缩功能的价值。 方法:声学采集60例单纯LADA患者和60例健康志愿者心脏动态数字化图像,获取16节段心肌长轴方向的速度、应变、应变率及其达峰时间进行分析。结果:LADA组收缩期和舒张期心肌速度、应变率及收缩期、舒张早期心肌应变明显低于对照组(P<0.01)。舒张晚期心肌应变两组比较差异无统计学意义(P>0.05)。LADA组各节段速度、应变、应变率的达峰时间较对照组有延长趋势,但差异无统计学意义(P>0.05)结论:VVI技术可无创性定量分析LADA患者心肌收缩、舒张功能,为早期评价亚临床状态的LADA患者心肌运动功能异常提供了一种新的可靠的工具。     

定量组织速度成像技术评价冠心病患者右心室功能的应用价值

[目的]探讨定量组织速度成像技术(QTVI)在冠心病(CAD)患者右心室局部舒缩功能的应用价值。[方法]应用QTVI获取45例CAD组和45例正常对照组右心室心肌不同位点的心肌多普勒速度曲线,分析并比较两组人群间收缩期峰值速度(Vs)、舒张早期峰值速度和舒张晚期峰值速度(Ve、Va)、计算Ve/Va、测量等容收缩时间(ICT)、等容舒张时间(IRT)、射血时间(ET)、心室舒张充盈时间(DFT)。[结果]CAD患者Vs、Ve、Ve/Va、ET、DFT均比正常对照组减低,Va、ICT、IRT均比正常对照组延长。[结论]CAD患者右心室局部舒缩功能受损,QTVI提供了一种精确、快速、无创地评价CAD患者右心室局部舒缩功能变化的新方法。     

组织速度结合应变率对完全性左束支传导阻滞的左室功能的分析

目的探讨组织速度(TVI)结合应变率对分析完全性左束支传导阻滞(CLBBB)患者的左室整体和局部收缩和舒张功能。方法对21例完全性左束支传导阻滞患者(CLBBB组)与20例正常者(正常对照组)采用组织速度结合应变率显像(SRI)技术分别测定其左室基底段及中段沿左室长轴运动的收缩期峰值速度(Vs)、峰值应变率(SRs)、舒张早期峰值速度(Ve)、舒张早期应变率(SRe)、舒张晚期峰值速度(Va)、舒张晚期应变率(SRa),并测定其左室射血时间(ET)和左室充盈时间(DFT)。用Simpson法测量左室射血分数(LVEF)。结果 (1)CLBBB组室间隔及左室下壁基底段及中段的Vs、Ve、SRs、SRe值均低于正常对照组(P<0.05);(2)CLBBB组ET、DFT均较正常对照组缩短(P<0.05)。(3)CLBBB组左室EF值与室间隔的Vs、Ve、SRs、SRe及DFT呈正相关(P<0.05)。结论组织速度结合应变率显像技术可作为CLBBB患者左室整体运动和局部舒缩活动的评价手段之一,为临床治疗提供了一定的参考价值。     

组织速度显像对急性心肌缺血下左室压力变化与左房功能影响的相关性研究

目的：应用超声组织速度显像（TVI）技术研究左室局部心肌缺血时左室压力变化对左房功能的影响。方法：11只犬行左冠状动脉前降支结扎，制作左室前壁心肌缺血模型。应用TVI技术测量缺血前后心房各壁的收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）及二尖瓣口血流频谱E／A、肺静脉血流频谱S峰和D峰值，同时导管记录缺血前后左室压力曲线。结果：心肌缺血后左房各壁Vs和Ve均增高（P〈0．001），左室舒张末期压力（LV—EDP）增高，且其缺血前后变化率（LVEDP％）分别与左房前壁、侧壁和下壁的Ve变化率（Ve％）呈正相关（r=0．72、0．73、0．83，P＝0．05、0．05、0．002）。结论；左房功能在局部心肌缺血时会受到增高的LVEDP的影响，表现为左房壁心肌纤维的运动能力随之增加。