Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the lef...Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the left ventricular endocardial borders.Their use during echocardiography has become a valuable tool in non-invasive diagnostics.UCAs provide higher-quality images that may ultimately reduce the length of hospital stays and improve patient care.The higher cost associated with UCAs in many situations has been an impediment to frequent use.However,when used as an initial diagnostic test,UCA during rest echocardiogram is more cost-effective than the traditional diagnostic approach,which frequently includes multiple tests and imaging studies to make an accurate diagnosis.They can be easily performed across multiple patient settings and provide optimal images that allow clinicians to make sound medical decisions.This consequently allows for better diagnostic accuracies and improvement in patient care.展开更多
Objective:To investigate the usefulness of the descending aortic retrograde flow area to forward flow area(dAO RF)ratio using echocardiography in managing pulmonary blood flow during the perioperative period following...Objective:To investigate the usefulness of the descending aortic retrograde flow area to forward flow area(dAO RF)ratio using echocardiography in managing pulmonary blood flow during the perioperative period following Blalock-Thomas-Taussig shunt(BTTS)surgery.Methods:This retrospective study analyzed patient characteristics,surgical procedures,and perioperative courses.The dAO RF ratio was measured upon admission to the pediatric intensive care unit(PICU)and 12,24,48,and 72 h post-surgery.Blood pressure,percutaneous oxygen saturation,arterial blood gas values,and lactate levels were measured at the same time as the dAO RF ratio.Results:Seventy-one cases were analyzed.Excessive and low pulmonary blood flow occurred in 17 and two patients,respectively.Four patients required resuscitation within 72 h post-surgery,due to excessive pulmonary blood flow.No deaths occurred within 72 h.The dAO RF ratio was significantly higher in patients with excessive pulmonary blood flow at PICU admission and at its maximum(p=0.049 and p<0.01,respectively).The maximum dAO RF ratio was significantly correlated with lactate levels when measured concurrently;however,there was clinical variability in the resuscitation cases.The dAO RF ratio cutoff of 0.61 was highly accurate(area under the receiver operating characteristic curve:0.91[95%confidence interval:0.82-1.00]),sensitive(82.4%),and specific(94.4%)for detecting excessive pulmonary blood flow.Conclusions:Measuring the dAO RF ratio postoperatively can prevent deterioration in patients with BTTS by accurately detecting excessive pulmonary blood flow,offering a minimally invasive and accurate assessment of perioperative pathophysiology.展开更多
Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosi...Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosis and obvious scoliosis under 10 years old.However,the fluoroscopic radiopaque of titaniumalloy plate will inevitably partly make the operative field of interventional occlusion blind.We presenta7-year-old Chinese girl with ASD and scoliosis who underwent spinal correction with a dual-growthrod.In this case,we performed transcatheter closure of ASD solely under the guidance of transthoracicechocardiography.Transthoracic echocardiography(TTE)has been reported as efficacious and safe forassessment and guidance of ASD occlusion.For patients with visual field occlusion under fluoroscopy,theapplication of TTE is efficacious and safe for assessmnent and guidance of ASD occlusion.展开更多
Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiograp...Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts(RLSs)in patients with PFO.In this letter,regarding an original study presented by Yao et al,we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.展开更多
Despite efforts to develop treatment technology for cardiac arrest (CA),CA incidence and mortality rates are still high.^([1,2])A recent study of CA patients in emergency departments revealed that the incidence of CA ...Despite efforts to develop treatment technology for cardiac arrest (CA),CA incidence and mortality rates are still high.^([1,2])A recent study of CA patients in emergency departments revealed that the incidence of CA is increasing annually,and the in-hospital survival rate of CA patients is only approximately 28.7%.^([3])Echocardiography has been widely used as an important monitoring tool in critical care and helps to identify the cause of shock,monitor hemodynamics,and guide fluid therapy utilization.^([4])One study reported that approximately one-third of patients underwent formal echocardiography during hospitalization in the intensive care unit (ICU).展开更多
Congenital heart disease(CHD)is the most common congenital anomaly and a major cause of death among fetal malformations,but prenatal diagnosis is considered to be low.The development of artificial intelligence(AI)in f...Congenital heart disease(CHD)is the most common congenital anomaly and a major cause of death among fetal malformations,but prenatal diagnosis is considered to be low.The development of artificial intelligence(AI)in fetal echocardiography has made it possible to automate and standardise the examination,improving the variation in CHD detection rates between different regions and reducing the reliance on operator experience.AI includes any computer program(algorithms and models)that mimics human logic and intelligence,and its use in fetal echocardiography is mainly to acquire and optimise images,perform automatic measurements,identify discrepant values,and diagnose and classify pathologies.In this review,we will look at the different practical applications of AI in fetal echocardiography.展开更多
The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to ass...The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.展开更多
Artificial intelligence(AI)technology has been increasingly used in medical field with its rapid developments.Echocardiography is one of the best imaging methods for clinical diagnosis of heart diseases,and combining ...Artificial intelligence(AI)technology has been increasingly used in medical field with its rapid developments.Echocardiography is one of the best imaging methods for clinical diagnosis of heart diseases,and combining with AI could further improve its diagnostic efficiency.Though the applications of AI in echocardiography remained at a relatively early stage,a variety of automated quantitative and analytical techniques were rapidly emerging and initially entered clinical practice.The status of clinical applications of AI in echocardiography were reviewed in this article.展开更多
BACKGROUND Patent foramen ovale(PFO)-related right-to-left shunts(RLSs)have been impli-cated in cryptogenic stroke and migraine,with larger shunts posing a higher risk.When used individually to detect RLS,contrast tra...BACKGROUND Patent foramen ovale(PFO)-related right-to-left shunts(RLSs)have been impli-cated in cryptogenic stroke and migraine,with larger shunts posing a higher risk.When used individually to detect RLS,contrast transcranial Doppler(cTCD)and contrast transthoracic echocardiography(cTTE)may yield false-negative results.Further,the literature exposes gaps regarding the understanding of the limitations of cTCD and cTTE,presents conflicting recommendations on their exclusive use,and highlights inefficiencies associated with nonsynchronous testing.AIM To investigate the accuracy of multimodal ultrasound to improve diagnostic efficiency in detecting PFO-related RLSs.METHODS We prospectively enrolled four patients with cryptogenic stroke(n=1),migraine(n=2),and unexplained dizziness(n=1)who underwent synchronized cTCD combined with cTTE.The participants were monitored and followed-up for 24 months.RESULTS cTTE identified moderate and large RLSs in patients with recurrent cryptogenic stroke and migraines,whereas cTCD revealed only small RLSs.Moderate and large RLS were confirmed on combined cTTE and cTCD.After excluding other causes,both patients underwent PFO occlusion.At 21-and 24-month follow-up examinations,neither stroke nor migraine had recurred.cTTE revealed a small RLS in a third patient with unexplained dizziness and a fourth patient with migraines;however,simultaneous cTCD detected a large RLS.These patients did not undergo interventional occlusion,and dizziness and headache recurred at the 17-and 24-month follow-up examin-ations.CONCLUSION Using cTTE or cTCD may underestimate RLS,impairing risk assessments.Combining synchronized cTCD with cTTE could enhance testing accuracy and support better diagnostic and therapeutic decisions.展开更多
Objective To explore the value of deep learning(DL)models semi-automatic training system for automatic optimization of clinical image quality control of transthoracic echocardiography(TTE).Methods Totally 1250 TTE vid...Objective To explore the value of deep learning(DL)models semi-automatic training system for automatic optimization of clinical image quality control of transthoracic echocardiography(TTE).Methods Totally 1250 TTE videos from 402 patients were retrospectively collected,including 490 apical four chamber(A4C),310 parasternal long axis view of left ventricle(PLAX)and 450 parasternal short axis view of great vessel(PSAX GV).The videos were divided into development set(245 A4C,155 PLAX,225 PSAX GV),semi-automated training set(98 A4C,62 PLAX,90 PSAX GV)and test set(147 A4C,93 PLAX,135 PSAX GV)at the ratio of 5∶2∶3.Based on development set and semi-automatic training set,DL model of quality control was semi-automatically iteratively optimized,and a semi-automatic training system was constructed,then the efficacy of DL models for recognizing TTE views and assessing imaging quality of TTE were verified in test set.Results After optimization,the overall accuracy,precision,recall,and F1 score of DL models for recognizing TTE views in test set improved from 97.33%,97.26%,97.26%and 97.26%to 99.73%,99.65%,99.77%and 99.71%,respectively,while the overall accuracy for assessing A4C,PLAX and PSAX GV TTE as standard views in test set improved from 89.12%,83.87%and 90.37%to 93.20%,90.32%and 93.33%,respectively.Conclusion The developed DL models semi-automatic training system could improve the efficiency of clinical imaging quality control of TTE and increase iteration speed.展开更多
The growing utilization of critical care echocardiography(CCE) by clinicians necessitates a meticulous review of clinical conditions in critically ill patients, both before and during the examination. The reviewing pr...The growing utilization of critical care echocardiography(CCE) by clinicians necessitates a meticulous review of clinical conditions in critically ill patients, both before and during the examination. The reviewing process of clinical conditions minimizes the risk of overlooking or misinterpreting crucial findings. This article proposes a comprehensive strategy, namely BILL strategy, to integrate into the CCE protocol, where "B" represents baseline respiratory and hemodynamic support, "I" signifies information gleaned from invasive monitoring, including central venous pressure and thermodilution-derived cardiac output, the first "L" denotes laboratory results such as central venous oxygen saturation, troponin, and brain natriuretic peptide, and the second "L" refers to lung ultrasound data. Combining the BILL strategy with CCE can enhance comprehensive understanding of critical conditions, potentially leading to improved diagnostic accuracy and patient outcomes.展开更多
Congenital heart disease(CHD)is the most common type of birth defect,representing a significant cause of peri-natal morbidity and mortality.Early diagnosis of such anomalies is crucial for improving outcomes.Current p...Congenital heart disease(CHD)is the most common type of birth defect,representing a significant cause of peri-natal morbidity and mortality.Early diagnosis of such anomalies is crucial for improving outcomes.Current pro-tocols recommend a qualitative assessment of cardiac structures using two-dimensional ultrasound(2DUS)and color Doppler imaging.In cases of suspected abnormalities,quantitative assessments through cardiac structure measurements and reference curves can aid in accurate diagnosis.Similar to centiles widely employed in obste-trics,Z-scores provide more precise quantification of various cardiac structures,particularly at the extremes of the curve.While the development of reference curves and Z-scores has progressed over the past two decades,a lack of standardization in measurements and statistical methodology for their determination is evident.Establishing reference curves requires adherence to specific recommendations to improve their accuracy.The purpose of this study is to provide a narrative review of the major studies that have generated reference values for cardiac struc-tures using 2DUS and Z-scores,to evaluate their methodology,and to provide a summary of the results.展开更多
Background Atrial septal defect(ASD)is one of the most common congenital heart diseases.The diagnosis of ASD via transthoracic echocardiography is subjective and time-consuming.Methods The objective of this study was ...Background Atrial septal defect(ASD)is one of the most common congenital heart diseases.The diagnosis of ASD via transthoracic echocardiography is subjective and time-consuming.Methods The objective of this study was to evaluate the feasibility and accuracy of automatic detection of ASD in children based on color Doppler echocardiographic static images using end-to-end convolutional neural networks.The proposed depthwise separable convolution model identifies ASDs with static color Doppler images in a standard view.Among the standard views,we selected two echocardiographic views,i.e.,the subcostal sagittal view of the atrium septum and the low parasternal four-chamber view.The developed ASD detection system was validated using a training set consisting of 396 echocardiographic images corresponding to 198 cases.Additionally,an independent test dataset of 112 images corresponding to 56 cases was used,including 101 cases with ASDs and 153 cases with normal hearts.Results The average area under the receiver operating characteristic curve,recall,precision,specificity,F1-score,and accuracy of the proposed ASD detection model were 91.99,80.00,82.22,87.50,79.57,and 83.04,respectively.Conclusions The proposed model can accurately and automatically identify ASD,providing a strong foundation for the intelligent diagnosis of congenital heart diseases.展开更多
Objective: This study aims to explore the application of echocardiography combined with blood-related detection indicators in the diagnosis and treatment of Kawasaki disease in children, assessing the potential advant...Objective: This study aims to explore the application of echocardiography combined with blood-related detection indicators in the diagnosis and treatment of Kawasaki disease in children, assessing the potential advantages of this combined diagnostic method for early diagnosis, disease monitoring, and evaluation of treatment efficacy, thereby providing more effective treatment strategies. Methods: The study included 50 children diagnosed with Kawasaki disease as the study group, and 50 children with upper respiratory infections as the control group. Both groups underwent echocardiographic examinations to assess cardiac structure and function, while monitoring changes in blood-related inflammatory markers. The differences in echocardiographic and blood-related indicators before and after treatment between the two groups were compared. Results: Echocardiography effectively assessed the cardiac structure and function of children with Kawasaki disease. It was found that the ejection fraction (EF) in the treatment group significantly decreased from 69.94 ± 5.93% before treatment to 65.70 ± 5.56% after treatment (P = 0.0019), while the control group showed no significant change (from 70.94 ± 6.27% to 69.18 ± 6.14%, P = 0.2073). The aortic diameter (AO) in the treatment group increased from 12.85 ± 2.77 mm to 13.17 ± 2.41 mm (P = 0.0000), while in the control group it decreased from 18.58 ± 6.66 mm to 17.64 ± 6.83 mm (P = 0.0000), indicating potential vascular remodeling. In terms of blood indicators, the C-reactive protein (CRP) in the treatment group significantly decreased from 65.82 ± 81.31 mg/L to 14.03 ± 17.94 mg/L (P = 0.028), while in the control group, CRP decreased from 30.66 ± 47.78 mg/L to 8.17 ± 11.71 mg/L (P = 0.0049). Other inflammatory markers, such as procalcitonin (PCT), also showed corresponding changes. Conclusion: This study demonstrates that echocardiography combined with blood-related detection indicators has significant application prospects in the diagnosis and treatment of Kawasaki disease in children. This combined diagnostic approach not only helps improve the diagnostic accuracy and treatment efficacy of Kawasaki disease but also offers new insights for individualized treatment. Further promotion and in-depth research of this combined diagnostic strategy will contribute to optimizing the clinical management of Kawasaki disease in children, improving patient prognosis and quality of life.展开更多
Objective: To evaluate of the role of transesophageal echocardiography (TEE)in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. Methods:Sixty- two patients (10 to 55 years of age...Objective: To evaluate of the role of transesophageal echocardiography (TEE)in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. Methods:Sixty- two patients (10 to 55 years of age) were selected for percutaneous closure of ASD bytrans-esophageal echocardiography, which was also used to monitor the procedure, to select theappropriate size of the Amplatzer device, to verify its position, and to access the immediateresults of the procedure. During the follow-up, transthoracic echocardiography (TTE) or TEE was usedto evaluate the presence and magnitude of residual shunt (RS), device position, and right cardiacchamber diameters. Results: The mean ASD diameter by TTE ([19. 1 +- 5. 8] mm) was significantlysmaller (P< 0. 001) than the stretched diameter of the ASD (25. 1 +- 6. 4) mm. There are nosignificant differences between the TEE -measured value (23. 5+_6. 2) mm and the stretched diameterof the ASD (P > 0. 05). Due to proper patient selection all procedures were successful. There wasimmediate and complete closure in 61/62 patients, only one patients had trivial residual shunt.Follow- up was performed using TTE or TEE right after operation, 1 d, 1 month, 3 months, 6 monthsand yearly thereafter. Ail, patients remain asymptomatic without any clinical or technical problems.Conclusion: With the aid of TEE, percutaneous closure of ASD can be performed successfully, safely,and effectively.展开更多
BACKGROUND Unroofed coronary sinus syndrome(UCSS)is a rare congenital heart disease,which has variable morphologic features and is strongly associated with persistent left superior vena cava(PLSVC).However,it is often...BACKGROUND Unroofed coronary sinus syndrome(UCSS)is a rare congenital heart disease,which has variable morphologic features and is strongly associated with persistent left superior vena cava(PLSVC).However,it is often difficult to visualize the left-to-right shunt pathway through the CS by transthoracic echocardiography(TTE).CASE SUMMARY A 37-year-old female was admitted to the hepatological surgery department of a hospital with complaint of subxiphoid pain that had started 1 wk prior.Physical examination revealed a grade 3/6 systolic murmur at the left margin of the sternum,between the 2nd and 3rd intercostal cartilage.The patient underwent echocardiography and was diagnosed with ostium primum atrial septal defect(ASD);thus,she was subsequently transferred to the cardiovascular surgery department.A second TTE evaluation before surgery showed type IV UCSS with secundum ASD.Right-heart contrast echocardiography(RHCE)showed that the right atrium and right ventricle were immediately filled with microbubbles,but no microbubble was observed in the CS.Meanwhile,negative filling was observed at the right atrium orifice of the CS and right atrium side of the secundum atrial septal.RHCE identified UCSS combined with secundum ASD but without PLSVC in this patient.CONCLUSION This rare case of UCSS highlights the value of TTE combined with RHCE in confirming UCSS with ASD or PLSVC.展开更多
AIM To evaluate the long-term outcome of catheter ablation of atrial fibrillation(AF)facilitated by preprocedural threedimensional(3-D)transesophageal echocardiography.METHODS In 50 patients,3D transesophageal echocar...AIM To evaluate the long-term outcome of catheter ablation of atrial fibrillation(AF)facilitated by preprocedural threedimensional(3-D)transesophageal echocardiography.METHODS In 50 patients,3D transesophageal echocardiography(3D TEE)was performed immediately prior to an ablation procedure(paroxysmal AF:30 patients,persistent AF:20 patients).The images were available throughout the ablation procedure.Two different ablation strategies were used.In most of the patients with paroxysmal AF,the cryoablation technique was used(Arctic Front Balloon,Cryo Cath Technologies/Medtronic;group A2).In the other patients,a circumferential pulmonary vein ablation was performed using the CARTO system[Biosense Webster;group A1(paroxysmal AF),group B(persistent AF)].Success rates and complication rates were analysed at 4-year follow-up.RESULTS A 3D TEE could be performed successfully in all patients prior to the ablation procedure and all four pulmonaryvein ostia could be evaluated in 84%of patients.The image quality was excellent in the majority of patients and several variations of the pulmonary vein anatomy could be visualized precisely(e.g.,common pulmonary vein ostia,accessory pulmonary veins,varying diameter of the left atrial appendage and its distance to the left superior pulmonary vein).All ablation procedures could be performed as planned and almost all pulmonary veins could be isolated successfully.At 48-mo followup,68.0%of all patients were free from an arrhythmia recurrence(group A1:72.7%,group A2:73.7%,group B:60.0%).There were no major complications.CONCLUSION3 D TEE provides an excellent overview over the left atrial anatomy prior to AF ablation procedures and these procedures are associated with a favourable long-term outcome.展开更多
The present study evaluated the application of three dimensional echocardigraphy （3DE） in the diagnosis of atrial septal defect （ASD） and the measurement of its size by 3DE and compared the size with surgical find...The present study evaluated the application of three dimensional echocardigraphy （3DE） in the diagnosis of atrial septal defect （ASD） and the measurement of its size by 3DE and compared the size with surgical findings. Two-dimensional and real-time three dimensional echocardiography （RT3DE） was performed in 26 patients with atrial septal defect, and the echocardiographic data were compared with the surgical findings. Significant correlation was found between defect diameter by RT3DE and that measured during surgery （r=0.77, P〈0.001）. The defect area changed significantly during cardiac cycle. Percentage change in defect size during cardiac cycle ranged from 6%-70%. Our study showed that the size and morphology of atrial septal defect obtained with RT3DE correlate well with surgical findings. Therefore, RT3DE is a feasible and accurate non-invasive imaging tool for assessment of atrial septal size and dynamic changes.展开更多
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 fu...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.展开更多
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...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.展开更多
文摘Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the left ventricular endocardial borders.Their use during echocardiography has become a valuable tool in non-invasive diagnostics.UCAs provide higher-quality images that may ultimately reduce the length of hospital stays and improve patient care.The higher cost associated with UCAs in many situations has been an impediment to frequent use.However,when used as an initial diagnostic test,UCA during rest echocardiogram is more cost-effective than the traditional diagnostic approach,which frequently includes multiple tests and imaging studies to make an accurate diagnosis.They can be easily performed across multiple patient settings and provide optimal images that allow clinicians to make sound medical decisions.This consequently allows for better diagnostic accuracies and improvement in patient care.
文摘Objective:To investigate the usefulness of the descending aortic retrograde flow area to forward flow area(dAO RF)ratio using echocardiography in managing pulmonary blood flow during the perioperative period following Blalock-Thomas-Taussig shunt(BTTS)surgery.Methods:This retrospective study analyzed patient characteristics,surgical procedures,and perioperative courses.The dAO RF ratio was measured upon admission to the pediatric intensive care unit(PICU)and 12,24,48,and 72 h post-surgery.Blood pressure,percutaneous oxygen saturation,arterial blood gas values,and lactate levels were measured at the same time as the dAO RF ratio.Results:Seventy-one cases were analyzed.Excessive and low pulmonary blood flow occurred in 17 and two patients,respectively.Four patients required resuscitation within 72 h post-surgery,due to excessive pulmonary blood flow.No deaths occurred within 72 h.The dAO RF ratio was significantly higher in patients with excessive pulmonary blood flow at PICU admission and at its maximum(p=0.049 and p<0.01,respectively).The maximum dAO RF ratio was significantly correlated with lactate levels when measured concurrently;however,there was clinical variability in the resuscitation cases.The dAO RF ratio cutoff of 0.61 was highly accurate(area under the receiver operating characteristic curve:0.91[95%confidence interval:0.82-1.00]),sensitive(82.4%),and specific(94.4%)for detecting excessive pulmonary blood flow.Conclusions:Measuring the dAO RF ratio postoperatively can prevent deterioration in patients with BTTS by accurately detecting excessive pulmonary blood flow,offering a minimally invasive and accurate assessment of perioperative pathophysiology.
基金supported by the National Natural Science Foundation of China(82271725).
文摘Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosis and obvious scoliosis under 10 years old.However,the fluoroscopic radiopaque of titaniumalloy plate will inevitably partly make the operative field of interventional occlusion blind.We presenta7-year-old Chinese girl with ASD and scoliosis who underwent spinal correction with a dual-growthrod.In this case,we performed transcatheter closure of ASD solely under the guidance of transthoracicechocardiography.Transthoracic echocardiography(TTE)has been reported as efficacious and safe forassessment and guidance of ASD occlusion.For patients with visual field occlusion under fluoroscopy,theapplication of TTE is efficacious and safe for assessmnent and guidance of ASD occlusion.
文摘Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts(RLSs)in patients with PFO.In this letter,regarding an original study presented by Yao et al,we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.
基金supported by China National High Level Hospital Clinical Research Funding (2022-PUMCH-B-110)。
文摘Despite efforts to develop treatment technology for cardiac arrest (CA),CA incidence and mortality rates are still high.^([1,2])A recent study of CA patients in emergency departments revealed that the incidence of CA is increasing annually,and the in-hospital survival rate of CA patients is only approximately 28.7%.^([3])Echocardiography has been widely used as an important monitoring tool in critical care and helps to identify the cause of shock,monitor hemodynamics,and guide fluid therapy utilization.^([4])One study reported that approximately one-third of patients underwent formal echocardiography during hospitalization in the intensive care unit (ICU).
文摘Congenital heart disease(CHD)is the most common congenital anomaly and a major cause of death among fetal malformations,but prenatal diagnosis is considered to be low.The development of artificial intelligence(AI)in fetal echocardiography has made it possible to automate and standardise the examination,improving the variation in CHD detection rates between different regions and reducing the reliance on operator experience.AI includes any computer program(algorithms and models)that mimics human logic and intelligence,and its use in fetal echocardiography is mainly to acquire and optimise images,perform automatic measurements,identify discrepant values,and diagnose and classify pathologies.In this review,we will look at the different practical applications of AI in fetal echocardiography.
基金supported by Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University)Clinical Capacity Enhancement and was awarded to the first author,Chanjuan Gong(Grant No.JSPH-MC-2022-4).
文摘The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.
文摘Artificial intelligence(AI)technology has been increasingly used in medical field with its rapid developments.Echocardiography is one of the best imaging methods for clinical diagnosis of heart diseases,and combining with AI could further improve its diagnostic efficiency.Though the applications of AI in echocardiography remained at a relatively early stage,a variety of automated quantitative and analytical techniques were rapidly emerging and initially entered clinical practice.The status of clinical applications of AI in echocardiography were reviewed in this article.
基金Supported by The Shenzhen Second People’s Hospital Clinical Research Fund of the Shenzhen High-level Hospital Construction Project,No.20223357021 and No.20243357001Research Project of Teaching Reform in Shenzhen Second People’s Hospital,No.202209Guangdong Province Basic and Applied Basic Research Fund Project,No.2020B1515120061.
文摘BACKGROUND Patent foramen ovale(PFO)-related right-to-left shunts(RLSs)have been impli-cated in cryptogenic stroke and migraine,with larger shunts posing a higher risk.When used individually to detect RLS,contrast transcranial Doppler(cTCD)and contrast transthoracic echocardiography(cTTE)may yield false-negative results.Further,the literature exposes gaps regarding the understanding of the limitations of cTCD and cTTE,presents conflicting recommendations on their exclusive use,and highlights inefficiencies associated with nonsynchronous testing.AIM To investigate the accuracy of multimodal ultrasound to improve diagnostic efficiency in detecting PFO-related RLSs.METHODS We prospectively enrolled four patients with cryptogenic stroke(n=1),migraine(n=2),and unexplained dizziness(n=1)who underwent synchronized cTCD combined with cTTE.The participants were monitored and followed-up for 24 months.RESULTS cTTE identified moderate and large RLSs in patients with recurrent cryptogenic stroke and migraines,whereas cTCD revealed only small RLSs.Moderate and large RLS were confirmed on combined cTTE and cTCD.After excluding other causes,both patients underwent PFO occlusion.At 21-and 24-month follow-up examinations,neither stroke nor migraine had recurred.cTTE revealed a small RLS in a third patient with unexplained dizziness and a fourth patient with migraines;however,simultaneous cTCD detected a large RLS.These patients did not undergo interventional occlusion,and dizziness and headache recurred at the 17-and 24-month follow-up examin-ations.CONCLUSION Using cTTE or cTCD may underestimate RLS,impairing risk assessments.Combining synchronized cTCD with cTTE could enhance testing accuracy and support better diagnostic and therapeutic decisions.
文摘Objective To explore the value of deep learning(DL)models semi-automatic training system for automatic optimization of clinical image quality control of transthoracic echocardiography(TTE).Methods Totally 1250 TTE videos from 402 patients were retrospectively collected,including 490 apical four chamber(A4C),310 parasternal long axis view of left ventricle(PLAX)and 450 parasternal short axis view of great vessel(PSAX GV).The videos were divided into development set(245 A4C,155 PLAX,225 PSAX GV),semi-automated training set(98 A4C,62 PLAX,90 PSAX GV)and test set(147 A4C,93 PLAX,135 PSAX GV)at the ratio of 5∶2∶3.Based on development set and semi-automatic training set,DL model of quality control was semi-automatically iteratively optimized,and a semi-automatic training system was constructed,then the efficacy of DL models for recognizing TTE views and assessing imaging quality of TTE were verified in test set.Results After optimization,the overall accuracy,precision,recall,and F1 score of DL models for recognizing TTE views in test set improved from 97.33%,97.26%,97.26%and 97.26%to 99.73%,99.65%,99.77%and 99.71%,respectively,while the overall accuracy for assessing A4C,PLAX and PSAX GV TTE as standard views in test set improved from 89.12%,83.87%and 90.37%to 93.20%,90.32%and 93.33%,respectively.Conclusion The developed DL models semi-automatic training system could improve the efficiency of clinical imaging quality control of TTE and increase iteration speed.
文摘The growing utilization of critical care echocardiography(CCE) by clinicians necessitates a meticulous review of clinical conditions in critically ill patients, both before and during the examination. The reviewing process of clinical conditions minimizes the risk of overlooking or misinterpreting crucial findings. This article proposes a comprehensive strategy, namely BILL strategy, to integrate into the CCE protocol, where "B" represents baseline respiratory and hemodynamic support, "I" signifies information gleaned from invasive monitoring, including central venous pressure and thermodilution-derived cardiac output, the first "L" denotes laboratory results such as central venous oxygen saturation, troponin, and brain natriuretic peptide, and the second "L" refers to lung ultrasound data. Combining the BILL strategy with CCE can enhance comprehensive understanding of critical conditions, potentially leading to improved diagnostic accuracy and patient outcomes.
文摘Congenital heart disease(CHD)is the most common type of birth defect,representing a significant cause of peri-natal morbidity and mortality.Early diagnosis of such anomalies is crucial for improving outcomes.Current pro-tocols recommend a qualitative assessment of cardiac structures using two-dimensional ultrasound(2DUS)and color Doppler imaging.In cases of suspected abnormalities,quantitative assessments through cardiac structure measurements and reference curves can aid in accurate diagnosis.Similar to centiles widely employed in obste-trics,Z-scores provide more precise quantification of various cardiac structures,particularly at the extremes of the curve.While the development of reference curves and Z-scores has progressed over the past two decades,a lack of standardization in measurements and statistical methodology for their determination is evident.Establishing reference curves requires adherence to specific recommendations to improve their accuracy.The purpose of this study is to provide a narrative review of the major studies that have generated reference values for cardiac struc-tures using 2DUS and Z-scores,to evaluate their methodology,and to provide a summary of the results.
基金the National Natural Science Foundation of China(61975056)the Shanghai Natural Science Foundation(19ZR1416000)+1 种基金the Science and Technology Commission of Shanghai Municipality(20440713100)the Scientific Development funds for Local Region from the Chinese Government in 2023(XZ202301YD0032C).
文摘Background Atrial septal defect(ASD)is one of the most common congenital heart diseases.The diagnosis of ASD via transthoracic echocardiography is subjective and time-consuming.Methods The objective of this study was to evaluate the feasibility and accuracy of automatic detection of ASD in children based on color Doppler echocardiographic static images using end-to-end convolutional neural networks.The proposed depthwise separable convolution model identifies ASDs with static color Doppler images in a standard view.Among the standard views,we selected two echocardiographic views,i.e.,the subcostal sagittal view of the atrium septum and the low parasternal four-chamber view.The developed ASD detection system was validated using a training set consisting of 396 echocardiographic images corresponding to 198 cases.Additionally,an independent test dataset of 112 images corresponding to 56 cases was used,including 101 cases with ASDs and 153 cases with normal hearts.Results The average area under the receiver operating characteristic curve,recall,precision,specificity,F1-score,and accuracy of the proposed ASD detection model were 91.99,80.00,82.22,87.50,79.57,and 83.04,respectively.Conclusions The proposed model can accurately and automatically identify ASD,providing a strong foundation for the intelligent diagnosis of congenital heart diseases.
文摘Objective: This study aims to explore the application of echocardiography combined with blood-related detection indicators in the diagnosis and treatment of Kawasaki disease in children, assessing the potential advantages of this combined diagnostic method for early diagnosis, disease monitoring, and evaluation of treatment efficacy, thereby providing more effective treatment strategies. Methods: The study included 50 children diagnosed with Kawasaki disease as the study group, and 50 children with upper respiratory infections as the control group. Both groups underwent echocardiographic examinations to assess cardiac structure and function, while monitoring changes in blood-related inflammatory markers. The differences in echocardiographic and blood-related indicators before and after treatment between the two groups were compared. Results: Echocardiography effectively assessed the cardiac structure and function of children with Kawasaki disease. It was found that the ejection fraction (EF) in the treatment group significantly decreased from 69.94 ± 5.93% before treatment to 65.70 ± 5.56% after treatment (P = 0.0019), while the control group showed no significant change (from 70.94 ± 6.27% to 69.18 ± 6.14%, P = 0.2073). The aortic diameter (AO) in the treatment group increased from 12.85 ± 2.77 mm to 13.17 ± 2.41 mm (P = 0.0000), while in the control group it decreased from 18.58 ± 6.66 mm to 17.64 ± 6.83 mm (P = 0.0000), indicating potential vascular remodeling. In terms of blood indicators, the C-reactive protein (CRP) in the treatment group significantly decreased from 65.82 ± 81.31 mg/L to 14.03 ± 17.94 mg/L (P = 0.028), while in the control group, CRP decreased from 30.66 ± 47.78 mg/L to 8.17 ± 11.71 mg/L (P = 0.0049). Other inflammatory markers, such as procalcitonin (PCT), also showed corresponding changes. Conclusion: This study demonstrates that echocardiography combined with blood-related detection indicators has significant application prospects in the diagnosis and treatment of Kawasaki disease in children. This combined diagnostic approach not only helps improve the diagnostic accuracy and treatment efficacy of Kawasaki disease but also offers new insights for individualized treatment. Further promotion and in-depth research of this combined diagnostic strategy will contribute to optimizing the clinical management of Kawasaki disease in children, improving patient prognosis and quality of life.
文摘Objective: To evaluate of the role of transesophageal echocardiography (TEE)in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. Methods:Sixty- two patients (10 to 55 years of age) were selected for percutaneous closure of ASD bytrans-esophageal echocardiography, which was also used to monitor the procedure, to select theappropriate size of the Amplatzer device, to verify its position, and to access the immediateresults of the procedure. During the follow-up, transthoracic echocardiography (TTE) or TEE was usedto evaluate the presence and magnitude of residual shunt (RS), device position, and right cardiacchamber diameters. Results: The mean ASD diameter by TTE ([19. 1 +- 5. 8] mm) was significantlysmaller (P< 0. 001) than the stretched diameter of the ASD (25. 1 +- 6. 4) mm. There are nosignificant differences between the TEE -measured value (23. 5+_6. 2) mm and the stretched diameterof the ASD (P > 0. 05). Due to proper patient selection all procedures were successful. There wasimmediate and complete closure in 61/62 patients, only one patients had trivial residual shunt.Follow- up was performed using TTE or TEE right after operation, 1 d, 1 month, 3 months, 6 monthsand yearly thereafter. Ail, patients remain asymptomatic without any clinical or technical problems.Conclusion: With the aid of TEE, percutaneous closure of ASD can be performed successfully, safely,and effectively.
文摘BACKGROUND Unroofed coronary sinus syndrome(UCSS)is a rare congenital heart disease,which has variable morphologic features and is strongly associated with persistent left superior vena cava(PLSVC).However,it is often difficult to visualize the left-to-right shunt pathway through the CS by transthoracic echocardiography(TTE).CASE SUMMARY A 37-year-old female was admitted to the hepatological surgery department of a hospital with complaint of subxiphoid pain that had started 1 wk prior.Physical examination revealed a grade 3/6 systolic murmur at the left margin of the sternum,between the 2nd and 3rd intercostal cartilage.The patient underwent echocardiography and was diagnosed with ostium primum atrial septal defect(ASD);thus,she was subsequently transferred to the cardiovascular surgery department.A second TTE evaluation before surgery showed type IV UCSS with secundum ASD.Right-heart contrast echocardiography(RHCE)showed that the right atrium and right ventricle were immediately filled with microbubbles,but no microbubble was observed in the CS.Meanwhile,negative filling was observed at the right atrium orifice of the CS and right atrium side of the secundum atrial septal.RHCE identified UCSS combined with secundum ASD but without PLSVC in this patient.CONCLUSION This rare case of UCSS highlights the value of TTE combined with RHCE in confirming UCSS with ASD or PLSVC.
文摘AIM To evaluate the long-term outcome of catheter ablation of atrial fibrillation(AF)facilitated by preprocedural threedimensional(3-D)transesophageal echocardiography.METHODS In 50 patients,3D transesophageal echocardiography(3D TEE)was performed immediately prior to an ablation procedure(paroxysmal AF:30 patients,persistent AF:20 patients).The images were available throughout the ablation procedure.Two different ablation strategies were used.In most of the patients with paroxysmal AF,the cryoablation technique was used(Arctic Front Balloon,Cryo Cath Technologies/Medtronic;group A2).In the other patients,a circumferential pulmonary vein ablation was performed using the CARTO system[Biosense Webster;group A1(paroxysmal AF),group B(persistent AF)].Success rates and complication rates were analysed at 4-year follow-up.RESULTS A 3D TEE could be performed successfully in all patients prior to the ablation procedure and all four pulmonaryvein ostia could be evaluated in 84%of patients.The image quality was excellent in the majority of patients and several variations of the pulmonary vein anatomy could be visualized precisely(e.g.,common pulmonary vein ostia,accessory pulmonary veins,varying diameter of the left atrial appendage and its distance to the left superior pulmonary vein).All ablation procedures could be performed as planned and almost all pulmonary veins could be isolated successfully.At 48-mo followup,68.0%of all patients were free from an arrhythmia recurrence(group A1:72.7%,group A2:73.7%,group B:60.0%).There were no major complications.CONCLUSION3 D TEE provides an excellent overview over the left atrial anatomy prior to AF ablation procedures and these procedures are associated with a favourable long-term outcome.
基金supported by a grant from the Youth Science Foundation of China (No.30600213)
文摘The present study evaluated the application of three dimensional echocardigraphy （3DE） in the diagnosis of atrial septal defect （ASD） and the measurement of its size by 3DE and compared the size with surgical findings. Two-dimensional and real-time three dimensional echocardiography （RT3DE） was performed in 26 patients with atrial septal defect, and the echocardiographic data were compared with the surgical findings. Significant correlation was found between defect diameter by RT3DE and that measured during surgery （r=0.77, P〈0.001）. The defect area changed significantly during cardiac cycle. Percentage change in defect size during cardiac cycle ranged from 6%-70%. Our study showed that the size and morphology of atrial septal defect obtained with RT3DE correlate well with surgical findings. Therefore, RT3DE is a feasible and accurate non-invasive imaging tool for assessment of atrial septal size and dynamic changes.
基金Supported by National Natural Science Foundation of China,No.81571686.
文摘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.
基金supported by the Natural Science Foundation of Hubei Province(No.2016CFB229)
文摘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.
