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Background Patients with both double orifice mitral valve (DOMV) and bicuspid aortic valve (BAV) malformation are rare. Although DOMV or BAV can be detected in some genetic syndromes, it has not been reported to simultaneously appear in Turner syndrome (TS). TrueVue, TouchVue, and TrueVue Glass are the latest technologies in advanced three-dimensional echocardiography (3DE), which is an important information supplement to two-dimensional echocardiography (2DE) for the diagnosis of congenital cardiac malformations. Herein we report the novel use of the above-mentioned technologies in the diagnosis and evaluation of a rare, combined valve malformation. Meanwhile, we also reviewed the literature for cases involving both DOMV and BAV and their association with various genetic syndromes. Case presentation We present the case of a 5-year-old girl diagnosed with TS because of a developmental delay. DOMV and BAV were found through echocardiographic examination. Three-dimensional transthoracic echocardiography as well as a series of novel advanced techniques were applied to clearly display the spatial structure of all tiers of the mitral valve apparatus, aortic valve, and arch to facilitate an accurate diagnosis. Conclusions This is the first case in which both DOMV and BAV were associated with TS. Innovative TrueVue and TrueVue Glass offer unprecedented photographic stereoscopic images, while TouchVue technology greatly improved the ultrasonic diagnostic workflow and the diagnostic performance of rare valve malformations by adding virtual light sources to display realistic light-shadow effects.

BACKGROUND Endocardial fibroelastosis (EFE) is a rare heart disease characterized by thickening of the endocardium caused by massive proliferation of collagenous and elastic tissue, usually leading to impaired cardiac function. Multimodality cardiovascular imaging for the evaluation of EFE with thrombi is even rarer. CASE SUMMARY We report a rare case of EFE associated with multiple cardiovascular thrombi. Three-dimensional (3D) and contrast echocardiography (CE) were used to assess ventricular thrombi. Anticoagulant therapy was administered to eliminate the thrombi. The peripheral contrast-enhanced thrombi with the highest risk were dissolved with anticoagulant therapy at the time of reexamination, which was consistent with the presumption of fresh loose thrombi. CONCLUSION This new echocardiography technique has a great advantage in the diagnosis and treatment of EFE. On the basis of conventional echocardiography, 3D echocardiography is used to display the position, shape, and narrow base of the thrombus. CE does not only help to confirm the diagnosis of thrombus, but also determines its risk.

Objective This study’s intent was to test a new system for scoring cardiac thrombotic stability, based on contrast-enhanced ultrasound (CEUS). Methods We used human whole blood for an in vitro thrombotic model involving 1-h (T1h) and 7-day (T7d) subsets. The T1h group was monitored for 1 h continuously to observe for the formation of a new thrombus on the original thrombus base. Changes in thrombotic CEUS images, histologic features, and shear wave elastography were recorded over time. We also studied 28 patients diagnosed with cardiac thrombi, each examined by transthoracic echocardiography and CEUS.Thrombi were scored for substrate (Ts) and hardness (Th) based on the visualized degree of contrast penetration into the thrombi. Statistical analyses of Ts and Th reflected thrombolytic time and risk of embolism to other organs. Results Histologically, the loosely constructed ends of in vitro thrombi solidified over time. In addition, the average Young’s modulus of thrombi over time indicated a progressive increase in hardness. Contrast-enhancing agents were able to penetrate fresh, loose thrombi only, not chronic, stable thrombi. As Ts and Th increased, prolonged thrombolytic time and greater risk of embolism to other organs were apparent. Conclusions Our data suggest that this new CEUS scoring system correlates well with cardiac thrombotic hardness and the quality of its underlying substrate, serving to quantify thrombotic stability.

Knowing the normal values of left ventricular (LV) systolic synchronicity in the early neonatal period is very important for understanding myocardial function. This retrospective study analyzed data of 105 newborns who were examined using real-time 3-dimensional echocardiography (RT3DE). The time to the point of minimal regional systolic volume (Tmsv) was measured from volume–time curves in each segment. Standard deviation (SD) and maximal difference (Dif) of Tmsv were calculated from 16 (6 basal/6 mid/4 apical), 12 (6 basal/6 mid), and 6 (basal) LV segments with the corresponding parameters adjusted for the R–R interval. Influences of age, sex, gestational age, birth weight, and heart rate on parameters were explored. Data showed no significant difference among Tmsv-16-SD, Tmsv-12-SD, and Tmsv-6-SD. A strong correlation was found between Tmsv-6-SD and Tmsv-6-Dif (r = 0.83, P

Background Myocardial fibrosis (MF) is thought to be associated with constrictive pericarditis (CP). miR-146a has been reported to be related to the survival of myocardial fibroblasts and related signal transduction pathways. The aim of this study was to investigate the expression of miR-146a in CP with MF and the activation of the Toll-like receptor 4 (TLR-4) signaling pathway, to understand the molecular mechanism of MF involvement in CP. Methods Thirty rats with different disease duration were randomly divided into three groups: an 8-week model group (CP-8W group), a 16-week model group (CP-16W group) model, and a normal control group (N group). After the CP model was established in the rats, the myocardial tissues were collected. The expression of miR-146a, the key factors of TLR-4 signaling pathway, including IL-1 receptor-associated kinase 1 (IRAK1), tumor necrosis factor receptor-associated factor 6 (TRAF6), nuclear factor-κB (NF-κB) and p-NF-κB, and the MF indicator α-SMA in myocardial tissue were detected. After treatment with lipopolysaccharide (LPS), primary cultured rat cardiac fibroblasts (CFs) were transfected with miR-146a. RT-PCR and western blot were used to detect the expression of downstream effectors to further verify the function of miRNA-146a in regulating MF via the TLR-4 signaling pathway. Results miR-146a was increased in the CP-8W group but not in the CP-16W group. IRAK1 and TRAF6 in the CP-16W group were found to be higher than in the N group and CP-8W group. α-SMA in the model groups was higher than in the N group. Compared with the CP-8W group, α-SMA in the CP-16W model group was further increased. In the experiments using CFs, the expression of IRAK1, TRAF6, p-NF-κB and α-SMA increased in the LPS-treated group compared with the N group. After transfection of CFs with the miR-146a mimics, the expression of IRAK1, TRAF6, p-NF-κB and α-SMA decreased compared with the LPS-treated group. Following transfection of CFs with miR-146a inhibitors, the expression of IRAK1, TRAF6, p-NF-κB and α-SMA increased compared with the LPS-treated group. Conclusions The expression of miR-146a demonstrated a dynamic change in the CP model; it was increased at the early time point (CP-8W) and then decreased at the 16W time point. miR-146a suppressed MF by inhibiting the target genes TRAF6 and IRAK1 via the TLR-4 signaling pathway.

Background Berry syndrome, a rare combination of cardiac anomalies, consists of aortopulmonary window (APW); aortic origin of the right pulmonary artery; interrupted aortic arch (IAA) or hypoplastic aortic arch or coarctation of the aorta; and an intact ventricular septum. There is lack of review articles that elucidate the clinical features, diagnosis, treatment, and outcomes of Berry syndrome. This publication systematically reviews the 89 cases published since 1982 on Berry syndrome. Case presentation A 38-year-old woman presented with a loud murmur and cyanosis. Transthoracic echocardiography demonstrated a severely dilated aorta and main pulmonary artery with a large intervening defect. Distal to the APW, the ascending aorta gave rise to the right pulmonary artery. Additionally, a type A IAA, an intact ventricular septum, and a large patent ductus arteriosus were revealed. Computed tomography angiography with 3-dimensional reconstruction confirmed above findings. This is the first report of a patient of this age with Berry syndrome who did not undergo surgery. Conclusions Berry syndrome is a rare but well-identified and surgically correctable anomaly. Patients with Berry syndrome should be followed up for longer periods to better characterize long-term outcomes.

An efficient animal model is fundamental for studies on the underlying mechanisms of constrictive pericarditis (CP). A novel CP rat model was established by pericardial injection composing of lipopolysaccharides (LPS) and talcum powder without thoracotomy. Pathological changes were confirmed by histological staining. E-flow Doppler of mitral valve, tissue Doppler E' in the medial mitral annular (E'sep ) and the lateral mitral annular (E'lat ) were measured to assess ventricular filling function. Circumferential, longitudinal, and radial strains (SC, SL and SR) and the respective strain rates (SrC, SrL and SrR) were analyzed in interventricular septum (IVS) and left ventricular free wall (LVFW). Rat cardiac fibroblasts (CFs) were treated with LPS. The activation of transforming growth factor β1 (TGF-β1) was confirmed by Q-PCR and western blot assays. Thickening of pericardium and fibrosis in pericardium and subepicardial myocardium were showed in the model group. Diastolic dysfunction in the CP group was indicated by decreased E'lat and E'lat /E'sep , increased E/E'lat , decreased EFW of SrC and SrL, increased AIVS and decreased E/A of SrC, SrL and SrR. Systolic dysfunction was indicated by decreased SCFW and SLFW in CP rats. The levels of TGF-β1, p-Smad2/3, α-smooth muscle actin (α-SMA), and collagen-I/III (COL-I/III) were increased in the CP group. The increased TGF-β1 that induced by LPS activated and phosphorylated Smad2/3 resulting in the secretion of α-SMA and COL-I/III. This model is of vital importance in studying the pathogenesis of CP.

OBJECTIVES In animal models with constrictive pericarditis (CP), detecting the function of cardiac systole by conventional noninvasive ultrasound is a challenge. We aimed to detect cardiac dysfunction in rat models with CP in the early stage by layered speckle tracking. METHODS We compared a rat CP model (n = 23, injected with a solution of 1-mg/mL lipopolysaccharides [0.5 mL] and a 10% talc suspension [0.5 mL]) with a control group (n = 20, no injection). After 8 weeks, conventional echocardiography and layered speckle tracking were used to assess the left ventricular structures and functions in the groups. RESULTS The global circumferential strain (CS) and longitudinal strain (LS) were decreased in the CP group (P

OBJECTIVES Interventricular septal geometry and motion reflect the interaction between the ventricles, and an abnormal shape and abnormal motion are always regarded as signs of increased right ventricular or pulmonary artery pressure. During the neonatal period, there are profound changes in the cardiac circulation. The aims of this study were to quantitatively analyze neonatal septal deformations under normal physiologic conditions and evaluate the changes in association with the hemodynamic changes occurring during the transitional period. METHODS This was a retrospective study of 114 healthy full-term neonates from birth to 14 days of age. Normalized septal curvatures were measured on left ventricular parasternal short-axis views during end diastole and end systole. The interventricular pressure gradient, ratio of ventricular volumes, septal strain, thickness, and some clinical characteristics were assessed, along with the association of these parameters with septal curvature. RESULTS All 4 normalized septal curvatures were found to have a significant correlation with the trans-septal pressure gradient (TSPG) and the end-diastolic volume ratio of the left and right ventricles (P

Purpose To investigate the relationship between hypoxia-inducible factor 1-alpha (HIF-1α), Twist family BHLH transcription factor 1 (TWIST-1), and β1 integrin (ITGB-1) expression and tumor stiffness, and evaluate performance of HIF-1α, TWIST-1, and ITGB-1 alone and in combination with Ki-67 for predicting pathological responses to neoadjuvant chemotherapy (NACT) in breast cancer (BC). Patients and methods This was a prospective cohort study of 104 BC patients receiving NACT. Tumor stiffness and oxygen score (OS) were evaluated before NACT by shear-wave elastography and optical imaging; HIF-1α, TWIST-1, ITGB-1, and Ki-67 expression were quantitatively assessed by immunohistochemistry of paraffin-embedded tumor samples obtained by core needle biopsy. Indexes were compared among different residual cancer burden (RCB) groups, and associations of HIF-1α, TWIST-1, ITGB-1, and Ki-67 with tumor stiffness and OS were examined. The value of HIF-1α, TWIST-1, ITGB-1, and Ki-67, and a possible new combined index (predRCB) for predicting NACT responses was assessed by receiver operating characteristic (ROC) curves. Results HIF-1α, TWIST-1, and ITGB-1 expression were positively correlated with tumor stiffness and negatively with OS. Area under the ROC curves (AUCs) measuring the performance of HIF-1α, TWIST-1, ITGB-1, and Ki-67 for predicting responses to NACT were 0.81, 0.85, 0.79, and 0.80 for favorable responses, and 0.83, 0.86, 0.84, and 0.85 for resistant responses, respectively. PredRCB showed better prediction than the other individual indexes for favorable responses (AUC = 0.88) and resistant responses (AUC = 0.92). Conclusion HIF-1α, TWIST-1, ITGB-1, and Ki-67 performed well in predicting favorable responses and resistance to NACT, and predRCB improved the predictive power of the individual indexes. These results support individualized treatment of BC patients receiving NACT.

Objective:To explore a differential diagnosis strategy for the causes of coronary artery dilatation (CAD) in infants．Methods: Clinical and echocardiography data for 243 infants with CAD from the Shengjing Hospital of China Medical University were analyzed retrospectively. The patients were divided into congenital and acquired groups according to the CAD causes.Results: The lesion detection rate for CAD in 22,925 infants who underwent echocardiography was 1.06% (243/22,925). The acquired group accounted for 84.77% (206/243) of participants, all of which had Kawasaki disease. The congenital group accounted for 15.23% (37/243) of patients, including coronary artery fistula [12.35% (30/243)], anomalous origin of the coronary artery [2.06% (5/243)], severe pulmonary stenosis [0.41% (1/243)], and moderate aortic stenosis [0.41% (1/243)]. There was no significant difference in the Z-score for CAD between the two groups of children (P>0.05). There were differences in the scope and shape of CAD between the two groups (all PConclusion: It is particularly important to diagnose the cause of CAD because its treatment depends on its etiology. When an echocardiography examination identifies CAD in infants, comprehensive and systematic analysis can quickly and accurately determine the cause of CAD according to the diagnostic strategy process and evaluation of dilatation and cardiac structure characteristics.

IntroductionPrevious studies on the surgical outcomes of aldosterone-producing adenoma (APA) patients were mainly based on the histopathological diagnosis of HE staining or adrenal venous sampling (AVS) instead of the functional pathology. The aim of the present study was to evaluate the surgical outcomes of APA patients based on the functional pathological diagnosis of APA according to HISTALDO (histopathology of primary aldosteronism) consensus.MethodsClinical data of 137 patients with suspected APA were analyzed retrospectively. All patients had hypertension and spontaneous hypokalemia. In all patients, CT showed a unilateral solitary hypodense adrenal lesion, and a contralateral adrenal gland of normal morphology. Tumors were removed and immunostained for CYP11B2, and their pathology were identified based on HISTALDO consensus. Patients were followed up 6 to 24 months after operation.ResultsAmong 137 cases of presumptive APA diagnosed by CT, 130 (95%) cases were pathologically diagnosed with classical pathology, including 123 APA(90%) and 7 aldosterone-producing nodule (APN) (5%). 7 cases (5%) had non-functioning adenoma (NFA) with aldosterone-producing micronodule (APM) or multiple aldosterone-producing micronodule (MAPM) in the surrounding adrenal tissue. In all 137 patients, hypertension was complete or partial clinical success postoperatively. Complete clinical success was achieved in 73 (53%), and partial clinical success was achieved in 64 (47%) cases. Serum potassium level recovered to normal in all. In 123 patients with APA, complete clinical success was reached in 67 (54%), and partial clinical success was reached in 56 (46%) cases. Gender, duration of hypertension and the highest SBP were significant independent predictors for cure of APA after surgery. A multiple logistic regression model integrating the three predictors was constructed to predict the outcome, which achieved a sensitivity of 72.4% and a specificity of 73.1%.ConclusionThe specificity of CT in the diagnosis of APA and APN patients with hypokalemia was 95%. All patients achieved complete or partial clinical success after surgery. Gender, duration of hypertension and the highest SBP were independent predictors for the postoperative cure of APA.

This study aimed to explore the incidence and clinical characteristics of multiple complications in children with Kawasaki disease (KD). All patients were diagnosed in our hospital between January 2016 and December 2020. A total of 640 cases were included, 43 patients had coronary artery aneurysm, 51 patients had coronary artery dilation, and 546 patients had no coronary artery damage. The patients were divided into three subgroups based on age: 1 year old, 1-5 years old, and 5 years old. The multiple complications of all the KD children and the correlation between extracardiac complications and cardiovascular complications were analyzed. Among the 640 KD children, most were 1-5 years old (415/640, 64.8%). Children 1 year old (31.6%) and 5 years old (28.3%) were more likely to have cardiovascular complications. The incidence of respiratory complications was highest in 1-5 year olds (57.1%). Involvement of the digestive and the hematological systems gradually decreased with age, whereas involvement of the nervous system, the urinary system, and the joints gradually increased with age. The incidence of cardiovascular injury with extracardiac complications (22.3%) was higher than that without extracardiac complications (16.3%), although the difference was not statistically significant (p 0.05).Conclusions: KD can be complicated by multiple-organ injury but there was no significant relationship between the occurrence of extracardiac complications and cardiovascular complications. What is Known: • Cardiovascular disease is generally believed to be the most common and serious complication of Kawasaki disease (KD). • Over recent years, we have found that extracardiovascular complications of KD are more common than generally supposed and, because they have some effect on prognosis, we believe that more attention should be paid to these complications. What is New: • There was no significant relationship between the occurrence of extracardiac complications and cardiovascular complications.

Aim To investigate the effectiveness of metformin in delaying or preventing progression to diabetes in a Chinese population with impaired glucose regulation (IGR). Materials and methods This multicentre, randomized, open-label, controlled study (NCT03441750) will assess the efficacy of metformin in preventing diabetes over ≥2 years. Eligible participants will be randomly assigned (1:1) to lifestyle intervention (LSI) or metformin plus LSI, with stratification based on blood pressure, anti-hypertensive medication use and isolated/non-isolated impaired fasting glucose. All participants will receive LSI advice. Participants in the metformin plus LSI group will receive metformin 850 mg once daily for the first 2 weeks, and twice daily thereafter, according to tolerability. Results The primary objective is to compare rates of newly diagnosed diabetes in the two intervention groups. Changes in glycaemia, blood pressure, body weight, insulin resistance, and safety outcomes will also be evaluated. Conclusions This large clinical trial in a Chinese population with IGR aims to provide critical information to guide clinical decision-making in order to alleviate the current diabetes epidemic.

Many transformer-based encoder-decoder models have made significant progress on summary generating tasks. And the availability of pre-trained models further improves its performance with self-supervised objectives on large text corpora. However, most models' architectures and their training criteria pay more attention to the lexical and syntactic structure rather than semantic similarity. In this paper, we augment training data in semantic space and propose Augmentation-based Semantic Mechanism (ASM) for encoder feedback with corresponding criterion to capture global semantic meanings. Notably, we enhance the encoder's comprehension of summaries in semantic space, and facilitate the integration of global semantics and local syntax during generating summaries. By leveraging pre-trained language models, we have driven our results to a new level (45.11 on CNN/DailyMail, 45.35 on XSum in ROUGE-1). Additionally, the human evaluation and further experiments also validate the effectiveness of our proposed method for generating abstractive summaries. Our augmented data and source code for summarization will be made public.

Objective:To identify factors predictive of coronary artery lesions (CALs) in children with Kawasaki disease (KD).Methods:The clinical data of 420 children with KD who were hospitalized between January 2018 and December 2020 were retrospectively evaluated after assignment to groups by the presence of coronary artery aneurysm (CAA), coronary artery dilation (CAD), or no CALs. The association between coronary artery damage and patient clinical and laboratory values was investigated by pairwise comparison of the three groups. Univariate and multivariate logistic regression identified independent risk factors. The predictive value of patient variables for development of CAA and CAD was estimated by receiver operating characteristic curve analysis.Results:CALs occurred in 17.6% (94/420) of children with KD. Duration of fever, cervical lymphadenopathy, intravenous immune globulin resistance, immunoglobulin (Ig)A, procalcitonin, hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein, and others differed between patients with CALs and without CALs and were significantly associated with the development of CAA and CAD. The largest area under the curve was for combined CAA or CAD indicators, 0.851 for CAA (sensitivity of 68.09% and specificity of 60.62%) and 0.714 for CAD (sensitivity of 65.96% and specificity of 70.77%). Fever of >7 days before treatment was predictive of severe CAA or CAD.Conclusion:Fever duration, ESR, IgA, Hb, and cervical lymphadenopathy were independent risk factors of CAA; CRP, ESR, and cervical lymphadenopathy were independent risk factors of CAD, with combined factors having increased sensitivity and specificity. Early, active treatment is essential to reduce the occurrence of CALs.

Purpose: This study explored the performance of prenatal ultrasonography in the differential diagnosis of cystic biliary atresia (CBA) and choledochal cyst (CC).Methods: Fetuses diagnosed with hepatic hilar cyst in the second trimester were included in this study. A series of prenatal ultrasound examinations were performed in the second and third trimesters. The diameter of the gallbladder (GB) and hepatic cyst were measured, as well as the wall thickness of the GB. The GB-cyst connection, visibility of the right hepatic artery (RHA), and other concomitant abnormalities were carefully evaluated. A neonatal transabdominal ultrasound examination was performed within 1 week after birth, and clinical data were followed up to 6 months after birth.Results: Between January 1, 2016 and January 31, 2020, 53 fetuses diagnosed with hepatic hilar cyst were recruited. Eight were excluded because they were lost to follow-up. Among the 45 cases included in this study, 10 were diagnosed with CBA and 35 with CC after birth. Statistically significant differences were found in GB width, wall thickness, change in GB width, change in cyst length, GB-cyst connection, and RHA visibility between the CBA and CC groups. GB width showed the best diagnostic performance with an area under the curve (AUC) of 0.899. The combination of GB width, GB wall thickness, and GB-cyst connection yielded a comparable AUC of 0.971.Conclusion: The GB should be carefully evaluated in fetuses with hepatic hilar cyst. Prenatal ultrasound findings could provide suggestive parameters for the differential diagnosis of CBA from CC.

Objective This study aimed to investigate the protective effects of naringin on myocardial deformation and oxidative responses in rats with sepsis-induced myocardial dysfunction (SIMD). Methods Global and segmental layer-specific longitudinal strain (LS) was assessed by speckle tracking echocardiography. Serum levels of creatine kinase, lactate dehydrogenase, superoxide dismutase, and malondialdehyde were measured. The activity of cleaved caspase-3 was determined by immunohistochemistry. Protein expression levels of Kelch-like ECH-related protein 1 (Keap1), nuclear erythroid factor 2-related factor 2 (Nrf2), and heme oxygenase-1 (HO-1) were measured by western blotting. Results Naringin inhibited the lipopolysaccharide-induced decrease in global and layer-specific LS of the left ventricle. Naringin also increased superoxide dismutase expression and decreased malondialdehyde, creatine kinase, lactate dehydrogenase, and cleaved caspase-3 expression in rats with SIMD. Furthermore, naringin increased Nrf2 and HO-1 protein expression levels, and decreased Keap1 protein expression levels in rats with SIMD. Conclusion Layer-specific LS analysis of myocardial function by speckle tracking echocardiography can reflect early changes in myocardial systolic function. Naringin may possess a protective effect through moderating lipopolysaccharide-induced myocardial oxidative stress via the Keap1/Nrf2/HO-1 pathway in rats with SIMD.

ObjectiveTo investigate the ability of tumor stiffness, tumor blood flow, and Ki-67 expression alone or in combination in predicting the pathological response to neoadjuvant chemotherapy (NACT) in breast cancer.Patients and MethodsThis prospective cohort study included 145 breast cancer patients treated with NACT. Tumor stiffness (maximum stiffness (Emax), mean stiffness (Emean)), blood score (BS), and their relative changes, were evaluated before (t0), during (t1–t5), and at the end of NACT (t6) by shear-wave elastography and optical imaging. Ki-67 expression was quantitatively evaluated by immunohistochemistry using core biopsy specimens obtained before NACT. Pathological responses were evaluated by residual cancer burden. The ability of tumor stiffness, BS, Ki-67, and predRCB—which combined ΔEmean (t2) (the relative changes in Emean after the second NACT cycle), BS2 (BS after the second NACT cycle), and Ki-67—in predicting tumor responses was compared using receiver operating characteristic curves and the Z-test.ResultsTumor stiffness and BS decreased during NACT. ΔEmean (t2), BS2, and Ki-67 had better predictive performance than other indexes in identifying a favorable response (AUC = 0.82, 0.81, and 0.80) and resistance responses (AUC = 0.85, 0.79, and 0.84), with no significant differences between the three (p > 0.05). PredRCB had better predictive performance than any parameter alone for a favorable response (AUC = 0.90) and resistance (AUC = 0.93).ConclusionTumor stiffness, BS, and Ki-67 expression showed good and similar abilities for predicting the pathological response to NACT, and predRCB was a significantly better predictor than each index alone. These results may help design therapeutic strategies for breast cancer patients undergoing NACT.

Background Ultrafast ultrasound imaging has been demonstrated to be an effective method to evaluate carotid stiffness through carotid pulse wave velocity (PWV) with high reproducibility, but lack of reference values has precluded its widespread use in clinical practice. This study aimed to establish reference values of PWV for ultrafast ultrasound imaging in a prospective, multicenter, population-based cohort study and to investigate the main determinants of carotid PWV. Methods A total of 1,544 healthy Han Chinese volunteers (581 [38%] men; age, 18–95 years) were enrolled from 32 collaborating laboratories in China. The participants were categorized by age, blood pressure (BP), and body mass index (BMI). The basic clinical parameters and the carotid PWV at the beginning of systole (BS) and end of systole (ES) were measured via ultrafast ultrasound imaging techniques. Results The PWV at both BS and ES was significantly higher in the left carotid artery than in the right carotid artery. The PWV at BS was significantly higher in men than in women; however, no significant difference was noted in the PWV at ES between men and women. Multiple linear regression analyses revealed that age, BP, and BMI were independently correlated with the PWV at both BS and ES. The PWV at BS and ES progressively increased with increase in age, BP, and BMI. Further, the age- and sex-specific reference values of carotid PWV for ultrafast ultrasound imaging were established. Conclusions Reference values of carotid PWV for ultrafast ultrasound imaging, stratified by sex and age, were determined for the first time. Age, BP, and BMI were the dominant determinants of carotid PWV for ultrafast ultrasound imaging, which should be considered in clinical practice for assessing arterial stiffness.

Pulmonary hypertension (PH) is a dangerous disease, featured by pulmonary vascular remodeling. Excessive proliferation of pulmonary artery smooth muscle cells (PASMCs) and pulmonary artery endothelial cells (PAECs) plays crucial roles in this process. MicroRNA-150 (miR-150) level has been found to be reduced in patients with PH, and correlated with the poor survival. This study aimed to investigate the beneficial effect of miR-150 on PH in hypoxia-induced rats, PASMCs and PAECs. The results showed that miR-150 level was reduced in the lung tissue and plasma of hypoxia-treated rats. Lentivirus-mediated overexpression of miR-150 restrained hypoxia-induced increase in right ventricular systolic pressure and decrease in cardiac output. Moreover, as assessed by HE staining, hypoxia-induced thickening of vessel wall was relieved by miR-150 up-regulation. Overexpression of miR-150 also suppressed hypoxia-induced formation of collagen fiber, expressions of α-SMA, TGF-β1, and collagen I in lung tissues and PASMCs. In addition, the excessive proliferation of PASMCs induced by hypoxia was repressed by miR-150 overexpression via AKT/mTOR signaling pathway. Increased NFATc3 expression in response to hypoxia was restrained by miR-150 overexpression in lung tissue and PAMSCs. Finally, miR-150 overexpression inhibited hypoxia-induced proliferation and apoptosis resistance in PAECs. In conclusion, these results indicate that miR-150 protects against hypoxia-induced pulmonary vascular remodeling, fibrosis, abnormal proliferation of PASMCs and PAECs, which suggests miR-150 as a promising therapeutic target for PH.

Glucose converted from a diet has been considered a high-risk factor of type 2 diabetes mellitus (T2DM). However, it is not clear how it increases the risk of T2DM. Here, we investigated the effect of high-glucose administration on glucose tolerence in wild-type and toll-like receptor 4 (TLR4) knockout mice. Mice were intragastrically administered with high-glucose. The level of fasting blood glucose, insulin and intraperitoneal glucose tolerance were measured, and insulinogenic index and HOMA-IR were calculated at 1 week. To understand mechanism of glucose action, we also assessed blood glucose, glucagon-like peptide-1 and inflammatory cytokines levels at different time windows following high-glucose load. Our results show that 20 g/kg glucose load leads to glucose tolerance impairment and insulin resistance in wild-type mice. Following 20 g/kg glucose load, the levels of plasma interlukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) increased significantly in wild-type mice, but not in TLR4 knockout mice. Moreover, 20 g/kg glucose load also impaired glucose-induced GLP-1 secretion in wild-type and TLR4 knockout mice. Our results indicate that high-glucose load leads to glucose intolerance with insulin resistance through impairment of GLP-1 secretion, increase of blood glucose levels via activating TLR4 and increasing levels of IL-6 and TNF-α in mice.

Primary malignant pericardial mesothelioma (PMPM) is an extremely rare tumor, which may appear as a localized or a diffuse mass encasing the heart. Diffuse PMPMs have a poor prognosis due to the difficulty of surgical excision, whereas localized PMPMs have clear margins, thus facilitating surgical excision. Timely diagnosis and proper treatment are crucial for a favorable prognosis. Eight cases of localized PMPMs have been reported so far, but their characteristics have not been fully described. Herein, we present a patient with localized PMPM and describe the diagnosis methods, treatment, and outcomes of these tumors.

OBJECTIVES The tissue motion of annular displacement provides an accurate and rapid assessment of left ventricular (LV) systolic function. However, it has rarely been used in patients with chronic constrictive pericarditis and restrictive cardiomyopathy. This study aimed to assess the differences in LV systolic function in patients with constrictive pericarditis and restrictive cardiomyopathy using tissue motion of annular displacement derived from speckle-tracking echocardiography. METHODS Twenty-four patients with constrictive pericarditis, 24 with restrictive cardiomyopathy, and 25 healthy volunteers (controls) were enrolled. The septal and lateral mitral annular longitudinal displacements, displacement at the midpoint, and normalized midpoint displacement of the mitral ring were calculated. RESULTS Mitral annular tracking and quantification of the tissue motion of annular displacement were achieved within 10 seconds. In patients with constrictive pericarditis, the lateral mitral annular longitudinal displacement, displacement at the midpoint, and midpoint displacement of the mitral ring were decreased, whereas the septal mitral annular longitudinal displacement was preserved compared to controls, indicating that the reduction of systolic function in constrictive pericarditis was caused by pericardial adhesion and calcium. In patients with restrictive cardiomyopathy, tissue motion of annular displacement was more reduced compared to patients with constrictive pericarditis and controls. The correlation between the septal mitral annular longitudinal displacement and left ventricular ejection fraction was 0.67 (P

A case of interruption of the aortic arch with double-outlet right ventricle is reported. Although the aortic arch was interrupted, there was no direct artery to supply blood to the descending aorta. However, a feeder vessel from the neck was found to be connected to the proximal descending aorta.

Objective Transabdominal ultrasound after oral administration of an echoic cellulose-based gastric ultrasound contrast agent (TUS-OCCA) has recently been suggested as a valuable mass-screening tool for gastric cancer. The aim of this study was to propose a producible stomach ultrasound reporting and data system (Su-RADS) using TUS-OCCA for gastric cancer screening. Patients The study includes information of 2738 patients who underwent both gastroscopy and TUS-OCCA examinations recorded in software system. Gastroscopy examination with pathological diagnosis was considered as gold standard. Various gastric lesions were classified into category 1–5 based on gastric wall thicknesses of them (especially the mucosa layer). Results The total malignant ratios of patients enrolled in this study were 17.1% (469/2738). The malignant ratios for category 1–5 were, respectively, 1.1, 1.7, 12.2, 34.2 and 78.1%. Category 2 indicated mild thickening of gastric wall at low risk for malignancy (1.7%); category 3 indicated moderate thickening at moderate risk for malignancy (12.2%); category 4 indicated severe thickening at high risk for malignancy (34.2%); category 5 indicated extremely severe thickening at extremely high risk for malignancy (78.1%). If category 2 was identified as cut-off point distinguishing between benign and malignant, the sensitivity and specificity by Su-RADS are 95.1 and 78.6%, respectively. Conclusion The Su-RADS system could inform the physicians about key findings, indicating the risk for malignancy and necessity of additional gastroscopy examination. Prospectively randomly controlled study design with larger clinical trial is needed for further investigations. Electronic supplementary material The online version of this article (10.1007/s10120-018-0798-x) contains supplementary material, which is available to authorized users.

A double-outlet left ventricle (DOLV) is a rare congenital cardiac malformation. Here, we describe a case of DOLV with bicuspid pulmonary valve, aortic coarctation, and a subpulmonary ventricular septal defect in which both ventricles were well developed. The anatomic features were observed with echocardiography, and the diagnosis was confirmed at surgery. Many variations of DOLV have been described. The features of our case expand the spectrum of this entity and may provide new insight into its complex anatomy.

Background Enteral nutrition should be implemented as early as possible in patients with moderate or severe acute pancreatitis. This study was designed to evaluate the feasibility and Deffectiveness of ultrasound-guided Freka-Trelumina tube placement for enteral nutrition in acute pancreatitis. Methods Patients with severe acute pancreatitis admitted to Shengjing Hospital of China Medical University who needed Freka-Trelumina tube placement for enteral nutrition and gastrointestinal decompression were included in the current study. The relevant evaluation indicators of tube placement included the success rate of tube placement, tube placement time, tube shift rate, and blocking rate. In addition, the evaluation indicators of ultrasound-guided tube placement (from 1 January 2018 to 31 July 2019) were compared with those of previous endoscope-guided placement (from 1 January 2015 to 31 December 2017) by analysing the data from the electronic medical record system. Results The success rate of ultrasound-guided tube placement was 90.7% (49/54). All 49 patients tolerated the Freka-Trelumina feeding tube. The average ultrasound-guided tube placement time for the 49 patients was 18.4 ± 12.8 min (range, 5–36 min). The Freka-Trelumina feeding tube had a shift rate of 10.2% (5/49). The blocking rate of the Freka-Trelumina feeding tube was 12.2% (6/49). The success rate of tube placement, tube shift rate and blocking rate for endoscope-guided tube placement were 100% (62/62), 11.3% (7/62), and 12.9% (8/62), respectively. The average endoscope-guided tube placement time for the 62 patients was 16.5 ± 5.7 min (range, 12–31 min). The comparison between the ultrasound-guided group and the endoscope-guided group showed that the success rate of tube placement, tube placement time, tube shift rate and blocking rate were similar. Conclusion The ultrasound-guided method can be done non-invasively at the bedside, which is safe and convenient, and the Freka-Trelumina feeding tube can be placed in time to achieve the goal of early enteral nutrition and gastrointestinal decompression.

Background Hepatocellular carcinoma (HCC) with right ventricle metastasis without inferior vena cava and right atrium involvement is very rare and the prognosis of HCC with RV metastasis is generally poor. The mass in the cardiac chamber may lead to lethal instability of hemodynamics, however, the initial symptom is probably non-specific, which means that diagnosis timely becomes even harder. Case presentation We present a 63-year-old male with isolated metastasis of HCC in the right ventricle which caused inflow obstruction. Moreover, we reviewed a series of studies of isolated metastasis of hepatocellular carcinoma between 1980 and 2018, and summarized the relative outcomes. Conclusions Isolated metastasis of hepatocellular carcinoma in the right ventricle is extraordinarily rare. It may damage cardiac structure and broke hemodynamic balance. Multimodality imaging plays an important in accurate pre-operation assessment. Nowadays, palliative treatments could relieve fatal symptoms to some degree, however, standard treatment has not been well established.

Background Among primary cardiac tumors, atypical lipoma is very rare. In particular, cases with lipomas in both the pericardium and the atria are even rare. Case presentation We report the case of a 49-year-old male patient presented to our department because of chest pain. Echocardiography revealed two large masses in both the pericardium and the right atrium. Then the tumors were completely resected and the histopathological examination revealed atypical lipoma. The patient recovered well without any complication and discharged from hospital. Conclusions We report a very rare case of a huge atypical lipomas located on the pericardium and right atrium. These tumors were easily detected by echocardiography and final diagnosed after surgical resection and pathological examination.

Objectives To assess the qualitative and quantitative characteristics of suspected cardiac masses by contrast-enhanced ultrasonography (CEUS) and to evaluate its usefulness. Methods Twenty-eight adult patients with suspected cardiac masses were selected for this study. All of them were examined by conventional transthoracic echocardiography (TTE) and CEUS. The location, attachment point, basement, morphology, size, boundary, internal echo, shape change, range of motion, length, area, effect on hemodynamics, and peak enhancement of the masses (A1), and adjacent normal myocardium (A2) were measured. Then, the A1 to A2 ratio was calculated and the above parameters were analyzed. Results The benign lesions showed regular morphology and clear-boundary uniform enhancement of the contrast agent. Malignant lesions showed an irregular shape, unclear boundary with surrounding tissue, and uneven enhancement of the contrast agent. The normal myocardial perfusion intensity was the same; there was no enhancement inside a simple thrombus, and the A1 of the benign lesion was lower than that of the normal myocardium (mean value [dB] ± SD, 0.63 ± 0.42); the A2 of the malignant lesion was higher than that of the normal myocardium (mean value [dB] ± SD, 1.49 ± 0.09). The difference in the ratio of A1 to A2 between groups was statistically significant (P Conclusions Contrast-enhanced ultrasonography can assess the basic biological characteristics and properties of cardiac masses and has a high diagnostic accuracy for differentiation of a thrombus from a tumor or a benign tumor from a malignant tumor.

Background Infantile hepatic hemangioma (IHH) is a rare endothelial cell neoplasm, which may be concurrent with severe complications and result in poor outcomes. Moreover, the coexistence of IHH and congenial heart disease is even rarer. Case presentation We present a 10-day-old male born with IHH associated with patent ductus arteriosus (PDA), atrial septal defect (ASD) and pulmonary hypertension. Moreover, we reviewed a series of studies of IHH-associated high-output cardiac failure between 1974 and 2018, and summarized the treatment outcomes. Conclusions Infantile hepatic hemangioma (IHH) has been known to induce high-output heart failure. There is no literature to summarize the severity of its impact on heart, which can lead to a high mortality rate. When IHH is detected by ultrasound, the heart should be evaluated to facilitate treatment. The outcomes of IHH associated with heart failure are good.

IntroductionAssisted reproductive technologies (ART), namely in vitro fertilisation and intracytoplasmic sperm injection, have become widely used to treat infertility. Although the use of ART is generally considered favourable, there are ongoing concerns about the prenatal and perinatal risks as well as long-term risks for the child. Epidemiological studies have demonstrated an association between pathological events during fetal development and future cardiovascular risk, raising concerns about cardiovascular remodelling in fetuses conceived by ART. The authors hypothesise fetuses conceived by ART present signs of cardioventricular dysfunction, which can be detected by deformation analysis. To address these issues, we will assess comprehensive cardiovascular structure and function in ART offspring and explore the role of speckle-tracking in myocardial deformation.Methods and analysisThis prospective observational cohort study will include 100 singleton pregnancies conceived by ART and 100 controls identified in fetal life and followed up to 6 months old. At inclusion, a baseline assessment of the mothers and ART characteristics will be recorded by interview and review of medical records. Between 28 and 32 weeks gestation, a detailed fetal echography will be performed, including an assessment of estimated fetal weight, fetoplacental Doppler, fetal echocardiography and fetal abdominal artery ultrasound. On delivery, maternal and neonatal characteristics will be assessed. Within 60 days of birth, the first postnatal cardiovascular assessment will be conducted which will include echocardiography and abdominal artery ultrasound. At 6 months of age, the second infants’ follow-up evaluation will include the weight and length of the infant, echocardiography and abdominal artery ultrasound. Data will be presented as mean±SD, median or percentages where appropriate. A pEthics and disseminationEthical approval has been obtained from the Ethics Committee of Shengjing Hospital of China Medical University. Findings will be disseminated through scientific publications and conference presentations.Trial registration numberChiCTR1900021672.

BACKGROUND: With the development of novel surgical techniques and instruments over the recent years, more and more surgeons consider single-port video-assisted thoracoscopic surgery (VATS) as a feasible option. However, whether single-port thoracoscopic surgery has more potential advantages than two-port thoracoscopic surgery for non-small cell lung cancer remains unknown. We conducted this systematic review and meta-analysis to compare the perioperative efficacy between single-port and two-port VATS anatomical lung resection for non-small cell lung cancer (NSCLC). METHODS: Eleven studies were identified from the databases of The Cochrane Library, PubMed, Embase, Web of science, and China Biology Medicine disc (CBMdisc). Prospective studies and retrospective studies that evaluated the perioperative efficacy of single-port VATS compared with two-port VATS were analyzed. We used 95% confidence intervals (CIs) to calculate the odds ratio (OR), and the weight mean difference (WMD). RESULTS: A total of 11 studies (3 prospective studies and 8 retrospective studies), including 1,592 patients, were included. We found that the duration of the operation in single-port VATS anatomical lung resection for NSCLC was shorter (P=0.02). Also, the bleeding volume amount was lower (P=0.01), the length of postoperative drainage was shorter (P

Primary coronary sinus tumors are extremely rare. Herein, we present a case of a pregnant woman with a primary myxoma in the coronary sinus (CS), which was diagnosed by echocardiography and computed tomography. We reviewed the literature and found two other primary CS tumors. We summarized the gender, ages, symptoms, diagnostic methods, associated anomalies, treatments, histologic findings, and outcomes of the 3 cases. Dyspnea was a common symptom of all 3 patients. Diagnostic methods included echocardiography, computed tomography, magnetic resonance imaging, and coronary angiography. Associated anomalies included coronary artery fistulas, coronary sinus orifice atresia with persistent left superior vena cava, intra-cardiac invasion, and pericardial effusion. The 3 histologic types of primary CS tumor were haemangioma, lymphoma, and myxoma. The 3 patients received proper treatment and had good therapeutic outcomes.

Purpose This study evaluated shear wave elastography (SWE) and SWE combined with the Ki-67 index as novel predictive modalities for the pathological response of invasive breast cancer to neoadjuvant chemotherapy (NAC). Methods The prospective study recruited 66 eligible patients from July 2014 to November 2015. Tumour stiffness, which corresponds with tumour progression and invasiveness, was assessed by quantitative SWE 1 d before biopsy (time point t0, elasticity E0), 1 d before next NAC cycle (t1−t5, E1−E5), and 1 d before surgery (t6, E6). The relative changes in SWE parameters after the first and second NAC cycles were considered as the variables [ΔE (t1), ΔE (t2)]. The pathological response was classified according to the residual cancer burden (RCB) protocol. Correlations between RCB scores and variables were evaluated. The predictive diagnostic performances of SWE parameters, Ki-67 index, and the predictive RCB (predRCB) score determined by a linear regression model were compared. Results Some immunohistochemical and molecular factors and SWE parameters were significantly different among the three RCB groups. The ΔE mean (t2) and Ki-67 had significantly better diagnostic performance than other parameters regarding predicting the pathological response (the RCB-I response and RCB-III resistance). However, the correlation between ΔE mean (t2) and Ki-67 index was significantly weaker as a diagnostic predictor ( r = 0.29). We generated a new predictive modality, predRCB, which is a multivariable linear regression model that combines ΔE mean (t2) and the Ki-67 index. The predRCB modality showed better diagnostic performance than SWE parameters and Ki-67 index alone. Conclusion Our findings highlight the potential utility for adding the Ki-67 index to the SWE results, which may improve the predictive power of SWE and facilitate personalising the treatment regimens of patients with breast cancer. These results should be validated in the future by performing a multicentre prospective study with a larger cohort.

Congenital coronary sinus (CS) stenosis is a rare malformation. We present five patients with congenital coronary sinus stenosis (CSS) and identified another nine cases reported in the literature between 1980 and 2016. Congenital CSS may be associated with an unroofed CS, a coronary artery-coronary sinus fistula, or other cardiac anomalies. Congenital CSS may be detected by echocardiography, multidetector row computed tomography, and intra-operative evaluation. Congenital CSS can occur at the ostium, lumen, and origin of the CS. Congenital CSS imaging features, treatment, and outcomes are summarized herein.

Unilateral lung agenesis, a rare congenital deformity, is secondary to abnormal embryonic development, leading to a shift of the mediastinum and remaining lung. In our case reports, we describe the diagnostic courses of two pediatric patients with unilateral lung agenesis admitted to our hospital in 2014. We present and compare the findings in transthoracic echocardiography with that in CT. Echocardiography played a pivotal role in revealing pulmonary deformities and leading to the diagnosis. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:514-517, 2016.

Coronary sinus (CS) orifice atresia is a rare malformation, usually associated with persistent left superior vena cava (PLSVC). The preoperative diagnosis is very challenging. The only clue for diagnosis is the reverse direction of flow through PLSVC. We present the case of a 69-year-old woman with CS orifice atresia and PLSVC. Then, we retrospectively study 99 cases of this malformation, including ours. This malformation is usually associated with the "enlarged" CS (>12 mm) and "small" PLSVC (≤5 mm), with the incidence of 81 and 87%, respectively, from the literature review.

Congenital double-orifice mitral valve (DOMV) is a rare malformation that may affect both mitral valve and apparatus, and it is usually associated with other cardiac disorders. Asymptomatic DOMV is extremely rare. We present two similar cases of asymptomatic congenital double-orifice mitral valve. Both cases presented functionally normal mitral valve apparatus with two equally sized orifices, which were formed by a central fibrosis. In addition, final confirmatory diagnosis was made using three-dimensional (3D) echocardiography in both cases.

Atrial septal aneurysm (ASA) is a localized deformity of the interatrial septum, which protrudes into the right and/or left atrium. ASA with defects is a source of cardiac embolism. Although transcatheter closure is now a common procedure, it is still challenging in patients with complicated ASA. We describe a case of giant atypical multiperforated ASA with irregular mobility, which showed a rare "aneurysm in aneurysm" structure. Real-time three-dimensional transesophageal echocardiography showed vivid images, which clearly demonstrated these irregular shaped defects mimicking the atriotomy view, and played a crucial role in guiding the transcatheter closure.

Purpose Explore the value of shear-wave elastography (SWE) parameters and dynamic optical breast imaging features for predicting pathological responses to neoadjuvant chemotherapy (NACT) in breast cancer (BC). Method This prospective cohort study included 91 BC patients receiving NACT. Tumor size, SWE (maximum stiffness [Emax] and mean stiffness [Emean]), blood score (BS), and oxygen score (OS) and their relative changes were collected before (t0), during (t1–t5), and after NACT (t6). The pathological response was classified according to the residual cancer burden. Relationships between tumor size, SWE stiffness, BS, and OS at t0–t6 were analyzed, and their predictive power was compared. Results During six NACT cycles, tumor size, tumor stiffness, and BS decreased, and tumor OS increased. ΔEmean (t2), E2mean, BS2, and OS2 had a greater power than other indexes for predicting a favorable response (AUC = 0.79, 0.71, 0.77, 0.78) and a resistance response (0.86, 0.74, 0.71, 0.71). For the favorable response, predictive power did not differ significantly between ΔEmean (t2), E2mean, BS2, and OS2, whereas for the resistance response, ΔEmean (t2) showed better prediction than E2mean, BS2, and OS2. Conclusions SWE stiffness, BS, and OS exhibited good and similar performances in predicting a NACT favorable response, and SWE stiffness showed better performance than BS and OS in predicting NACT resistance. These results may provide an important reference for individualized treatment in BC patients receiving NACT.

Aim To predict the spontaneous closure of ventricular septal defect (VSD) and assist pediatrician to manage VSD children. Methods Between January 2008 and December 2016, 132 children diagnosed with isolated VSD by echocardiography were enrolled. All participating children were followed-up by echocardiography yearly until the closure of VSD or 6 years old. The clinical indicators and echocardiographic parameters of patients were collected. Statistically significant factors were used to establish a Logistic Regression model for predicting spontaneous closure of VSD. Receiver operating characteristic (ROC) analysis was used to assess the specificity and sensitivity of Logistic Regression model. Results Spontaneous closure occurred in 60% of all patients; 57% in perimembranous VSD (p-VSD) and 64% in muscular VSD (m-VSD) patients. Initial diagnosis age, defect size, aneurysms tissue of the ventricular membranous septum (ATVMS), pulmonary hypertension (PH), and left ventricular diastolic dimension (LVDD) were statistically significant. Defect size, ATVMS and LVDD were determined by the Logistic Regression model as representative factor. P-VSD and m-VSD model had areas under the ROC curves 0.854 and 0.898, respectively. Conclusion We inferred that defect size, ATVMS and LVDD were characteristic and representative predictors for spontaneous closure of VSD. And we summarized the prognostic factors and recommended a follow-up criteria to assist the pediatrician managing VSD children.

Of the primary cardiac tumors, well-differentiated papillary mesothelioma (WDPM) is very rare, with only one case report documenting WDPM of the pericardium. We report herein a 17-year-old boy who had an abnormal chest X-ray on a routine college-entrance examination. A giant cardiac tumor was detected by echocardiography. The neoplasm was partially resected, and histopathological examination revealed a WDPM. The patient recovered without any complication.

Background Infective endocarditis (IE) is a rare disease with high mortality. Right-sided IE accounts for 5–10% of cases of IE. The tricuspid valve is most commonly affected, oppositely in coronary sinus (CS). The diagnoses, treatments and outcomes of CS vegetation has not been summarized yet. Case presentation We present a 71-year-old man complained of cough and fever. Transthoracic echocardiography revealed the aneurysmal dilated CS with the band medium-echo mobile structure. A sinus venosus atrial septal defect has been detected. He had a persistent left superior vena cava which drained the right atrium via the aneurysmal dilated CS. Blood cultures were positive for Staphylococcus aureus. After intravenous antibiotic therapy, he had the symptom of dyspnea. The suspicious diagnosis is recurrent septic lung emboli which was confirmed by thoracic contrast enhanced computed tomography. The thoracotomy was performed to repair the atrial septum and remove the CS vegetation. Ten days later, the patient was discharged with only mild cough. Conclusion Both positive blood cultures and echocardiography are major criteria in right-sided IE with CS vegetation. Current treatment options of CS vegetation include medical therapy and surgery. The surgical strategy for CS vegetation should be individualized, due to the controversial indications and optimum time of surgery. Most people have a good prognosis after proper treatment.

Crisscross heart(CCH) is a rare congenital anomaly. CCH is always with rare complex congenital heart malformations, and for this reason it is difficult to diagnose. We present an asymptomatic 29-year-old pregant woman with history of cardiac murmur at 28 weeks of gestation. Transthoracic echocardiography revealed a CCH with situs inversus, concordant atrioventricular, double outlet right ventricle, ventricular septum defect and pulmonary stenosis. The anomalies were demonstrated by two-dimensional echocardiography and confirmed by color Doppler imaging. The patient was stable and did not require surgical interventions. She underwent successful term vaginal delivery without complication and her baby had a normal heart. Patients with CCHs can be diagnosed by a careful, systematic study with two-dimensional and Doppler echocardiography to identify the ventricular morphology and position, determine the sequence of connections and spatial relationships of the cardiac chambers and identify other abnormalities.

Pulmonary artery sarcoma (PAS) is an extremely rare malignancy. It is usually found after it grows large enough to occupy almost the entire lumen of the pulmonary artery and causes serious clinical symptoms. Thus, it is usually difficult to distinguish PAS from pulmonary thromboembolism based on imaging examinations. Few case reports had shown the attachment of PAS to pulmonary artery, a key characteristic for diagnosis, and differential diagnosis of PAS. In this case, we found a PAS, which did not cause local obstruction and some tumor emboli, which obstructed the branches of the pulmonary arteries and caused pulmonary hypertension and clinical symptoms. Transthoracic echocardiography (TTE) revealed a part of the tumor attached to the intima of the main pulmonary artery with a peduncle and had obvious mobility, which was suggestive of PAS and differentiated it from the pulmonary thromboembolism. To our knowledge, this is the first case report of a pedunculated PAS suggested by TTE. Combined with pulmonary artery computed tomography angiography, the diagnosis of PAS is strongly suggested before the operation. This case indicates that TTE could reveal the attachment and mobility of PAS in the main pulmonary and may provide useful information for the diagnosis and differential diagnosis of PAS, especially a pedunculated PAS.

Background Fetal interrupted aortic arch (IAA) is a rare cardiac anomaly and its prenatal diagnosis is challenging. The purpose of our report is to evaluate the use of two-dimensional echocardiography (2DE) and 4D echocardiography with B-flow imaging and spatiotemporal image correlation (4D BF-STIC) in detecting IAA type A (IAA-A). Materials & Methods Twenty-three cases of confirmed IAA-A identified by fetal echocardiography were involved in the study. The fetal echocardiography image data were reviewed to analyze the ratio of right ventricle to left ventricle (RV/LV) diameter, the ratio of main pulmonary artery to ascending aorta (MPA/AAO) diameter, and the correlation of RV/LV diameter ratio and size of ventricular septal defect (VSD). 4D BF-STIC was performed in 21 fetuses using the sagittal view (4D BF-STIC-sagittal) and the four-chamber view (4D BF-STIC-4CV) as initial planes of view. An additional 183 normal fetuses were also included in our study. RV/LV and MPA/AAO ratios were calculated and compared with that of IAA-A fetuses. Fetal 2DE, 4D BF-STIC-sagittal, and 4D BF-STIC-4CV were used to visualize the aortic arch and its associated neck vessels. Six subgroups were evaluated according to gestational age. Results Fetal 2DE, 4D BF-STIC-sagittal, and 4D BF-STIC-4CV made the correct prenatal diagnosis of IAA-A in 19/23 (82.6%), 14/21 (66.7%), and 19/21 (90.5%) of patients, respectively. A significantly enlarged MPA combined with symmetric ventricles was found in the IAA-A fetuses, while the size of the VSD was negatively correlated with RV/LV ratio. 4D BF-STIC-sagittal and 4D BF-STIC-4CV were better than traditional 2D ultrasound in detecting the aortic arch and neck vessels between 17 and 28 gestational weeks and 29 to 40 gestational weeks in normal fetuses. Conclusion It is demonstrated that IAA-A could be diagnosed by traditional fetal echocardiography, while 4D technique could better display the anatomic structure and the spatial relationships of the great arteries. Use of volume reconstruction may promote its clinical usage and help prenatal diagnosis.