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The intubation of conventional transesophageal echocardiography (TEE) probes into patients causes serious esophagus irritation, and thus the use of TEE probes in pediatric practice is limited. In this study, we aimed at the development of a special probe which could be inserted through the nasopharyngeal cavity into the esophagus to obtain the same high-quality echocardiography images as those obtained by conventional TEE and improve patients' experience. During the examination, the patients felt relaxed for a longer time and cooperated with the sonographers in the process of cardiac catheterization conducted in the surgery room or the intensive care unit (ICU), resulting in improved accuracy of the diagnosis and timely administration of appropriate treatment. Two years ago, Prof. Xin-fang WANG put theories into practice by inserting the probe through the nasal cavity and pharynx into the esophagus of volunteers to successfully detect the heart and great vessels at the retrocardiac space. Later, Prof. Ming-xing XIE performed the transnasal TEE examination in 12 atrial septal defect (ASD) patients and proved the safety and reliability of this method, which could become a new way for clinical diagnosis and treatment.

Background: Left ventricular (LV) dysfunction in patients with coronary artery disease is shown by strain and strain rate imaging. However, left atrium (LA) function in patients with coronary artery disease (CAD) has not been assessed by this method., Methods and Results: In 34 CAD patients, including 17 patients with enlarged LA (LA diameter ≤ 4.0 cm) and 17 with normal-size LA (LA diameter ≤ 4.0 cm), two-dimensional strain echocardiographic imaging (2DSE) was performed. Twenty healthy subjects as a control group were included. Both conventional parameters and strain parameters, such as LA peak systolic strain (LAs S/SR), preatrial contraction strain (LAa S), peak systolic (LAs SR), early diastolic strain rate (LAe SR) and late diastolic strain rate (LAa SR), were measured. Conventional parameters were abnormal in CAD patients with enlarged LA (ELA), but there were no significant differences between CAD with normal-size left atrium (NLA) and control groups. LAs S/SR and LAe SR were lower in patients than in normal controls, and were even lower in CAD-ELA group (P < 0.05). LAa S/SR were lower in CAD patients with ELA (P < 0.05), but without a significant difference between CAD-NLA and control groups. A significant correlation was observed between LAs S/SR and LA emptying fraction (r = 0.85, P < 0.05; r = 0.72, P < 0.05, respectively). LAa S/SR related well to LA ejection fraction (r = 0.68, P < 0.05; r = 0.61, P < 0.05, respectively). LAs SR was most accurate in identifying both CAD patients with NLA from controls and CAD patients from controls (area under the curve: 0.91; 0.95, respectively)., Conclusions: LA diastolic dysfunction occurs prior to LA systolic dysfunction in CAD patients, and LAs SR is the most accurate index in identifying patients with CAD., (© 2011, Wiley Periodicals, Inc.)

Background: Rotation of the left ventricular (LV) apex to the base, or LV torsion, is related to myocardial contractility and structure and has recently been recognized as a sensitive indicator of cardiac performance, but it has been difficult to measure. The recent development of 2-dimensional (2D) speckle tracking imaging (STI) may provide a powerful means of assessing LV torsion. This study was conducted to evaluate the global and regional LV twist in patients with anterior wall myocardial infarction (AMI) disease before and after revascularization by STI., Methods: 2D STI was performed in 35 AMI patients before and one month after revascularization, as well as in 32 normal controls. Left ventricular global and regional rotations were obtained at basal and apical short-axis levels; LV torsion was defined as apical rotation relative to the base. The time sequences were normalized to the percentage of systolic and diastolic duration., Results: Before revascularization, LV peak regional and global torsion in patients with AMI were significantly reduced as the result of reduced apical and basal rotation relative to those of normal control group (all P < 0.001); most significantly in the anterior and anterior-septal regions (P < 0.001); one month after revascularization, there were significant changes in peak rotation at either the base or apex relative to pre-revascularization values (all P < 0.001). Similarly, peak regional and global LV torsion were increased significantly (all P < 0.001). Global torsion inversely correlated with EDV (r = -0.605, P = 0.028) and ESV (r = -0.638, P = 0.019); and positively correlated with LVEF (r = 0.630, P = 0.021). Tight relations were also found between torsion and LV longitudinal and short axis function., Conclusions: Systolic torsion was decreased in AMI patients. Revascularization therapy can improve the LV function of the AMI patients. STI has a potential to quantify left ventricular global and segment torsion in patients with AMI, and may make the assessment more available in clinical and research cardiology.

The objective of this study was to analyze echocardiographic characteristics of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and to explore the diagnostic value of transthoracic echocardiography. The echocardiographic characteristics of 8 patients hospitalized with ALCAPA from 2000 to 2005 were analyzed retrospectively, including the results of real time three-dimensional echocardiography in one case, and compared with angiographic results. Eight cases included 6 older type patients and 2 infant type patients. Echocardiography showed abnormal vessel inserting into pulmonary artery (PA), continuous shunt into PA and intercoronary collateral signals within the ventricular septum in all cases and bifurcate structure of the abnormal vessel with retrograde filling in 4 cases. The morphological and functional changes and valvular regurgitation induced by insufficient myocardial perfusion were also evaluated. In former 4 patients, 2 cases were misdiagnosed as right coronary artery-PA fistula and the other 2 cases were given an uncertain diagnosis of anomalous origin of the coronary artery because of the visualization of the echo-free linear structure which apparently arose from the aorta resembling a normal left coronary artery. The latter 4 patients were correctly diagnosed by excluding the aforementioned interference. The diagnosis of ALCAPA was confirmed by angiocardiography in all patients and by intraoperative findings in 4 patients. Based on the apprehension of ultrasonic features and the enhancement of diagnostic alertness, the echocardiography can evaluate ALCAPA accurately and give more information than angiography. It may be the first diagnostic choice.

Background: Both real-time three-dimensional echocardiography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy of RT3DE combined with MCE for quantitative evaluation of myocardial perfusion defects., Methods: Thirteen dogs underwent ligation of the left anterior descending artery (LAD, n = 6) or distal branch of the left circumflex artery (LCX, n = 7) under general anaesthesia. Three to four ml of a perfluoropropane (C3F8) microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with a commercially available Philips SONOS-7500 ultrasound system. After removal of the dog hearts, Evans blue dye was injected via the left and right coronary arteries to stain the myocardium at risk. In vitro anatomic measurements of myocardial mass after removal of the animals' hearts were used as controls., Results: Left ventricular (LV) mass determined by RT3DE ranged 36.7 - 68.9 g [mean, (54.6 +/- 9.6) g] before coronary artery ligation, and correlated highly (r = 0.99) with in vitro measurement of LV mass [range, 38.9 - 71.1 g; mean, (55.6 +/- 9.3) g]. There was no significant difference between RT3DE and in vitro measurements of LV mass [range, 36.7 - 68.9 g; mean, (51.3 +/- 12.5) g. Or range, 38.9 - 71.1 g; mean, (53.7 +/- 12.3) g, respectively] and under-perfused mass [range, 0 - 21.4 g; mean, (12.0 +/- 6.9) g. Or range, 0 - 19.8 g; mean, (10.8 +/- 6.3) g, respectively] after the LAD ligation (P > 0.05). Likewise, no significant difference was present between RT3DE and in vitro measurements of LV mass [range, 50.1 - 65.4 g; mean, (57.5 +/- 5.9) g. Or range, 51.5 - 65.8 g; mean, (57.3 +/- 6.4) g, respectively] and under-perfused mass [range, 0 - 25.6 g; mean, (13.3 +/- 9.6) g. Or range, 0 - 22.7 g; mean, (12.8 +/- 8.1) g, respectively] after the LCX ligation (P > 0.05). For all the animals with coronary ligation, LV mass measured by RT3DE ranged 35.9 - 68.6 g [mean, (54.8 +/- 10.0) g] and there was no significant difference between RT3DE and in vitro measurements of LV mass and under-perfused mass (P > 0.05, r = 0.99). Further, the under-perfused mass derived from RT3DE [range, 0 - 25.6 g; mean, (12.7 +/- 8.2) g] correlated strongly with the in vitro measurements [range, 0 - 22.7 g; mean, (11.9 +/- 7.2) g] (r = 0.96)., Conclusion: RT3DE with MCE is a rapid and accurate method for estimating LV myocardial mass and quantifying perfusion defects.

Conjoined twins (CT) are rare with possible serious malformations in which soft tissue, bone, or some organs are joined in utero. The extent of cardiac fusion and intracardiac anatomy of CT determine the viability, natural history, and outcome of potential surgical intervention. Early prenatal diagnosis and assessment may provide a window of opportunity to counsel the family for their informed decision on the pregnancy and to plan for prenatal and perinatal care. In this report, we describe a case of thoracopagus twins diagnosed by fetal echocardiography at 23-week gestation. The 2 hearts fused at the atrial and ventricular levels. The outcome and review of literature on fetal echocardiographic characteristics of this malformation are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore the value of transthoracic and right heart contrast echocardiography in the diagnosis of coronary sinus septal defect (CSSD), also known as unroofed coronary sinus. Methods: The echocardiographic characteristics of 20 patients with CSSD who underwent surgery in our hospital between October 1999 and June 2012 were reviewed retrospectively, including results of 9 cases studied by contrast echocardiography, and compared with surgical results. Results: Of the coronary sinuses in these 20 patients, 40% were totally unroofed, 35% partially unroofed in mid-portion, 20% partially unroofed in terminal portion, and 5% mixed type (mid- and terminal portions). Of these 20 patients, 65% were associated with other types of atrial septal defects, and 65% had a persistent left superior vena cava. The diagnostic accuracy of echocardiography for the CSSD was 65%. In patients whose diagnoses were confirmed by echocardiography, the accuracy for the types of CSSD was 84.6%. All of the first 6 cases studied before 2002 were either undiagnosed or misdiagnosed, and 78.6% of the last 14 cases studied were diagnosed accurately. Of 9 patients who underwent contrast echocardiography, 8 were correctly diagnosed, including 5 type II and 3 Raghib syndromes. 1 case of type IIIa was misdiagnosed as Raghib syndrome. Conclusions: The combination of transthoracic and contrast echocardiography can diagnose and classify CSSD accurately in most cases and should be the first choice for diagnosing CSSD. [Copyright &y& Elsevier]

Mitral valve area (MVA) in 30 patients with mitral stenosis (MS) and 34 normal controls was calculated by real-time, 3-dimensional echocardiography (RT3DE); MVA in patients with MS correlated well with the mitral area determined by 2-dimensional echocardiography (r = 0.98) and by pressure half-time (r = 0.90). MVA in normal controls on RT3DE correlated well with MVA on 2-dimensional echocardiography (r = 0.94) and pressure half-time (r = 0.91). There were significant differences between the orifice areas in patients with MS and normal controls. RT3DE can provide not only the anatomic structure of mitral valve apparatus, but also the optimal plane of the smallest mitral valve orifice, and can thus accurately measure the MVA. [Copyright &y& Elsevier]

Live three-dimensional echocardiography (L3DE) is an important breakthrough in the field of medical ultrasound. It will provide a great potential tool for clinical diagnosis and treatment. In this article, the authors first review the bottlenecks in 3D cardiac imaging and the technical principles of L3DE that have been used to overcome some of these problems. We then discuss the scanning methods, clinical usefulness, and the future of L3DE, drawing on our experiences in examining 124 human patients and in conducting animal verification studies with a live 3D ultrasound system. (ECHOCARDIOGRAPHY, Volume 20, October 2003) [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the value of echocardiography in the diagnosis of different pathological patterns of sinus of Valsalva aneurysms (SVAs). Methods: Echocardiographic features and surgical findings of 212 consecutive patients with SVAs treated in the last 17years (1995–2012) at the Union Hospital of Huazhong University of Science and Technology were compared and analyzed retrospectively. Results: 212 Chinese patients with SVAs underwent surgical repairs from January 1995 to May 2012 in our hospital. The aneurysms originated from the right, non-, multiple and left coronary sinus in 77.8%, 19.3%, 2.4% and 0.5%, respectively. 71.7% were ruptured, most commonly into the right ventricle (67.9%) followed by the right atrium (27.4%). Other rare entry sites of rupture included the left atrium, the left ventricle, the interatrial septum, the interventricular septum and the pulmonary artery (0.5%–1.9%). 164 SVAs arising from the right coronary sinus were classified by the Sakakibara method: 47.6% type I, 33.5% type II, 6.1% type IIIv and 12.8% type IIIa. 41 aneurysms of the non-coronary sinus were classified by the Guo method: 61.0% type I, 34.1% type IIa and 4.9% type IIv. The three most common associated cardiovascular lesions were ventricular septal defect (VSD) (53.3%), stenosis of right ventricular outflow tract (RVOTS) (7.5%) and aortic valvular malformations (5.2%). Compared with surgical results, the sensitivity, specificity and accuracy of echocardiographic diagnosis of SVAs were 93.9%, 99.9% and 99.8%, respectively. Of the 13 SVAs that were missed on echocardiography, 77% were small aneurysms of the right coronary sinus extending into the right ventricle across a VSD. Of the 199 cases diagnosed by echocardiography prior to surgery, the diagnostic accuracy of aneurismal origination, termination and whether ruptured or not was 99.0%, 99.0% and 97.5%, respectively. Echocardiography also diagnosed accurately all of the complications of the SVAs with the exception of aneurismal vegetations. The sensitivity, specificity and accuracy of echocardiography in diagnosing the associated cardiovascular lesions were 89.2%, 99.9% and 99.0%, respectively. The most common misdiagnosis and misdiagnosed associated lesions were the RVOTS and the types of VSD, respectively. Conclusions: Echocardiography has a specific value in the diagnosis of different pathological patterns of the SVAs with distinguishing ultrasonic features. To the best of our knowledge, this is the largest series of patients with SVAs surgically treated in a single medical center. [Copyright &y& Elsevier]