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Stanford type A aortic dissection (AAD) may affect the supra-aortic arteries, which are associated with acute ischemic stroke (AIS) or transient ischemic attack (TIA). This study aimed to investigate cerebral perfusion, the infarction incidence and risk factors in AAD patients.A total of 156 consecutive AAD patients were enrolled and divided into two groups according to whether the aortic arch branches were involved: the affected group (n = 90) and the unaffected group (n = 66). Clinical, echocardiographic/carotid Doppler data and cerebral infarction morbidity were compared between the groups. Independent predictors of 30-day AAD mortality were identified through multivariable Cox regression, and perioperative risk factors were analyzed.In total, 57.7% of AAD patients had aortic arch branch involvement. Abnormal Doppler waveforms were more common in the affected group (p 0.05). Regarding intracranial perfusion, the blood flow volumes (BFVs) of the bilateral internal carotid arteries (ICAs) and right vertebral artery (RVA) in the affected group were significantly reduced (p 0.05). The incidence of cerebral infarction in the affected group was significantly higher than that in the unaffected group (35.6% vs. 19.7%, p = 0.031). Multivariable analysis revealed that age45 years old, right internal carotid artery (RICA) involvement and reduced left ventricular ejection fraction (LVEF) were significant predictors of perioperative death.Aortic arch branch involvement is common in patients with AAD and is associated with reduced cerebral blood flow (especially on the right side) and a higher incidence of cerebral infarction. Age, extension of the RICA dissection and LVEF impairment are independent risk factors for AAD-related death.

The unilateral absence of pulmonary artery (UAPA) is a rare congenital cardiovascular malformation, which is asymptomatic and easy to be ignored in early stage. A large number of complications may occur in the later stage. Therefore, early diagnosis and treatment is of great significance. The imaging data of 49 patients with UAPA discovered and confirmed clinically by the echocardiography in our hospital are analyzed. The results show that left pulmonary artery absence is more common (55%) and most of them are associated with other cardiovascular malformations (92%). Atrial septal defect and patent foramen ovale were most common in 56%. In which the absence of isolated pulmonary artery was 8% (4/49), and the absence of right pulmonary artery was 75% (3/4). Especially in the patients with tetralogy of Fallot, 77% (5/9) of them miss the diagnosis of UAPA. This suggests that doctors and sonographers should pay attention to the development of pulmonary artery bifurcation and left and right branches in multi-section, and strengthen the scanning of short axis section of high large artery.

Surgical resection is the conventional therapeutic action for patients with an obstructive cardiac tumor. However, for patients in poor clinical condition, cardiac operation can be risky. We report on the successful percutaneous radiofrequency (RF) ablation treatment of a right ventricular giant myxoma in a 70-year-old woman with right ventricular outflow tract (RVOT) and pulmonary artery stenosis, who was unable to tolerate operation. The treatment was effective in relieving RVOT stenosis and improving symptoms. We believe the RF ablation may also be used as a supplementary technique for the treatment of obstructive cardiac tumors, when only partial resection is possible.

This study aimed to evaluate the instantaneous biological response of canine myocardium in vivo to high-intensity focused ultrasound (HIFU) ablation, and thereby determine the feasibility of this method.Left ventricle myocardium HIFU ablation was performed on six dogs at four levels of HIFU energy (acoustic intensity was 3000 W/cm2 ; ablation durations were 1.2, 2.4, 3.6, and 4.8 sec, respectively). Gross lesion volumes were confirmed and assessed by tetrazolium chloride (TTC) staining, hematoxylin-eosin (HE) staining, and electron microscopy. Global cardiac function and focal wall motion were evaluated by echocardiography. Blood enzymes and cardiac troponin T (CTnT) were tested after ablation. HIFU ablation was repeated on another set of six fresh canine hearts in vitro at the same four energy levels. Focal maximum temperatures were detected both in vivo and in vitro.Different sizes of ablation via HIFU can be created in beating hearts using controlled energy emission. Focal maximum temperatures varied from 62 ± 4.8 °C to 81 ± 12.9 °C. The lesion sizes were significantly smaller in vivo than in vitro, as verified by TTC and HE staining. Focal wall motion immediately decreased after ablation (P0.05), although the ejection fraction (EF) and E/A ratio were unchanged (P0.05). Enzymes and CTnT immediately increased.HIFU can be used for the controllable ablation of myocardial tissue, with instantly increased serum markers, decreased regional wall motion, and unaffected left ventricular global function.

A declining amplitude of body temperature circadian rhythm (BTCR) predicts decompensation or death in cardiomyopathic hamsters. We tested the hypothesis that changes in BTCR amplitude accompany significant changes in left ventricular (LV) size and function.Using intraperitoneal transmitters, we continuously monitored the temperature of 30 male BIO TO-2 Syrian dilated cardiomyopathic hamsters. Cosinor analysis was used to detect significant changes--defined as changes1 standard deviation from the baseline amplitude for 3 consecutive days--in BTCR amplitude over each hamster's lifespan. The Student t-test was used to compare BTCR variability and LV size and function (as assessed by 2D echocardiography) between baseline and the time that BTCR amplitude declined. All hamsters received 10 mg/kg furosemide daily. At the time of BTCR amplitude decline, functional parameters had changed significantly (P.0001) from baseline: ejection fraction (0.31 ± 0.09% vs. 0.52 ± 0.08%), LV end-systolic volume (0.11 ± 0.03 vs. 0.05 ± 0.02 cm(3)), and LV end-diastolic volume (0.16 ± 0.04 vs. 0.10 ± 0.03 cm(3)).In decompensated cardiomyopathic hamsters, a decline in BTCR amplitude was associated with progression of heart failure and cardiac decompensation. Variation in BTCR warrants further investigation because of its potential implications for the diagnosis and treatment of cardiovascular disorders.

Background: Loss of synchronous contraction between or within the right and left ventricle (RV, LV) leads to adverse ventricular function. We used real time three-dimensional echocardiography (RT3DE) for evaluation of severity of interventricular dyssynchrony and function in a porcine heart model. Methods: Six fresh in vitro porcine hearts were used to create a controlled model of LV and RV dyssynchrony using two sets of pulsatile pumps. Synchronized and dyssynchronized pump settings were used with two different dyssynchronized settings: LV filled first and RV filled first. Results: There was good correlation between actual measurement and RT3DE for interventricular time difference (r = 0.95, P < 0.0001) and stroke volume (SV) for LV and RV (0.89, 0.85; P < 0.0001, respectively). RT3DE data showed a small but significant underestimation for actual volume (P < 0.05). The intra- and interobserver variabilities are 2.9 ± 1.5% and 3.1 ± 5.4% for LV and RV SVs, and 1.7 ± 2.4% and 2.2 ± 3.2% for time differences by RT3DE. There was significant difference in RV SV between synchrony and dyssynchrony when the RV filled first (P < 0.05), but not in other groups. The same pattern was found in RT3DE derived SVs (synchrony versus dyssynchrony with RV filled first, P < 0.05). Conclusions: There is no compromise in LV SV during interventricular dyssynchrony; but RV SV was significantly diminished when the RV filled first. RT3DE is a feasible, robust and reproducible method to identify interventricular dyssynchrony and to evaluate ventricular SVs. (Echocardiography 2010;27:709-715)

Background: Torsion of the left ventricle is related to myocardial architecture and contractility and is being evaluated as a sensitive marker of cardiac performance. New 2-D speckle tracking imaging (STI) may provide a powerful means of assessing LV torsion noninvasively. This study sought to evaluate the global and regional left ventricular twist in patients with anterior wall myocardial infarction (AMI) before and after revascularization by STI. Methods: A total of 50 subjects, including study group (n = 20) who underwent revascularization for AMI as well as 1 month after revascularization, and control group (n = 30) of normal individuals were studied using STI. LV twist was defined as apical rotation relative to the base. The peak LV twist, standard deviation of time to peak twist (Tw-SD) and maximal temporal difference of time to peak twist (Tw-diff) of 6 myocardial regions were measured. Results: Before revascularization, peak LV twist was significantly reduced while Tw-SD and Tw-diff significantly increased in patients with AMI as compared with normal control group ( P ). There were significant correlations between LV peak twist and LVEF ( r =0.78, P r =−0.63, P Conclusion: LV twist measures significantly diminished and dys-synchronized in AMI patients prior to revascularization and improved after revascularization. STI measures correlate with EF and have the potential to quantify left ventricular global and segmental dysfunction in patients with AMI. Left ventricular regional and global peak twist, torsion and synchrony measures

Background : Thoracic aortic aneurysm and dissection (TAAD) is the leading cause of death in patients with Marfan syndrome (MFS) and other aortic disease (AD). The natural history of AD aries significantly. The size of the aorta alone does not always predict the risks of complications, such as catastrophic TAAD. Objectives : We sought to develop an ultrasound technique to quantitatively measure deformation of the ascending aorta (Ao) using a real-time 2-D ultrasound speckle tracking imaging (USTI) technique to investigate: alterations in biomechanical properties of AAo in MFS, and early and sensitive markers for TAAD for MFS. Methods: A total of 40 patients (MFS: n=18, age=11.4 ± 6.2 years, versus Control: n = 22, age=10.2 ± 4.3, p = 0.46) were prospectively enrolled. Real-time 2-D echocardiography was performed. The dimension of the AAo root (at the level of aortic annulus, sinus of Valsalva (SOV), sino-tubular junction and ascending aorta) was tracked and measured continuously in the cardiac cycle to derive the maximal and minimal systolic and diastolic dimensions using USTI (Philips Medical Systems). These measurements were used to yield dimensions, strain (deformation), strain rate (rate of deformation), distensibility, stiffness index and elastic modulus. Results: The results were summarized in Table 1 . Compared with controls, the MFS group had significantly enlarged dimension of the AAo root (P Conclusions: This study demonstrated the feasibility of quantitative measurement of the biomechanical properties of the AAo in MFS using USTI. We have also shown significant deterioration of the biomechanical properties in MFS. Table 1. Biomechanical properties of AAO in MFS