Daxin Zhou

Early clinical experience with a novel self-expanding percutaneous stent-valve in the native right ventricular outflow tract

Balloon expandable transcatheter pulmonary valve systems are not applicable to the large majority of patients with chronic severe pulmonary regurgitation (PR) following surgical right ventricular outflow tract (RVOT) rehabilitation. This report describes the clinical use and short‐term follow‐up of a novel transcatheter self‐expanding pulmonary valve system (Venus P Valve) for rehabilitation of the RVOT in patients with chronic severe PR.

Right Ventricular Regional Systolic Function and Dyssynchrony in Patients with Pulmonary Hypertension Evaluated by Three-Dimensional Echocardiography

BACKGROUND The aim of this study was to evaluate right ventricular (RV) regional systolic function and dyssynchrony in patients with pulmonary hypertension (PH) using real-time three-dimensional echocardiography. METHODS Real-time three-dimensional echocardiographic images were acquired to obtain RV regional (inflow, body, and outflow) ejection fraction (EF) and time to minimum systolic volume in 70 patients with PH and 26 normal controls. Pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance measured by echocardiography in all subjects and by right heart catheterization in 17 patients were recorded. RESULTS Inflow EF and global EF were significantly lower in patients with PH than in controls (P < .05). Body EF was significantly decreased in patients with moderate (PASP, 50-69 mm Hg) and severe (PASP ≥ 70 mm Hg) PH (P < .05). Outflow EF was significantly lowered in patients with severe PH (P < .001). The standard deviation of regional time to minimum systolic volume corrected by heart rate was significantly prolonged in patients with severe PH (P < .05). Inflow EF and global EF were negatively correlated with PASP (r = -0.731 and r = -0.769, respectively, P < .001) and with pulmonary vascular resistance (r = -0.789 and r = -0.801, P < .001). CONCLUSIONS In patients with PH, RV inflow and global systolic function was impaired in inverse relationship with PASP and pulmonary vascular resistance. RV systolic synchronicity was impaired in patients with severe PH. Evaluation of RV regional systolic function using real-time three-dimensional echocardiography may play a potential role in the noninvasive assessment of the severity of PH.

BMPR2 mutation is a potential predisposing genetic risk factor for congenital heart disease associated pulmonary vascular disease.

BACKGROUND Pulmonary arterial hypertension (PAH) frequently arises in patients with congenital heart disease (CHD) and can lead to pulmonary vascular disease (PVD). The present study was initiated to distinguish the predisposing effect of bone morphogenetic protein receptor 2 (BMPR2) in CHD by comparing the different mutation features of BMPR2 between CHD patients with or without PVD. METHODS AND RESULTS 294 CHD-PVD and 161 CHD without PVD patients were enrolled. PAH was diagnosed by heart catheterization at rest after CHD was first recognized by echocardiography. PVD was defined as a pulmonary vascular resistance (PVR) more than 3 Wood units. BMPR2 gene was screened by direct sequencing. A total of 24 mutations were identified, accounting for 22 of the 294 patients with CHD-PVD (7.5%) and 2 of the 161 CHD patients without PVD (1.2%, P=0.004). Female/male CHD-PVD patient ratio was 1.6:1, while in the BMPR2 mutation carriers female patients were more dominant (4.5:1, P=0.042). A significant higher BMPR2 mutation rate (12.6%) was found in repaired CHD-PVD (P=0.010). BMPR2 mutations in CHD-PVD patients were identified in different clinical phenotypes. Missense mutation of BMPR2 is the dominant mutation type. CONCLUSION Genetic predisposing factor may be an important component in the process of development of PVD in CHD patients. Female, repaired patients are more likely to be detected with genetic mutations.

Transcatheter closure of a post-myocardial infarction ventricular septal rupture using a parachute device.

A 58-year-old man with exertional dyspnea (New York Heart Association class II) was admitted to our hospital. He suffered from acute anterior myocardial infarction 1 year earlier and had undergone percutaneous coronary intervention and closure of ventricular septal rupture (VSR) with an Amplatzer

Role of three-dimensional transesophageal echocardiography in transcatheter aortic valve implantation of bicuspid aortic valve stenosis: A controlled study and comparison with tricuspid aortic valve stenosis

Aims: This study aims to investigate the application of three-dimensional transesophageal echocardiography in aortic valve stenosis for the assessment of aortic valve ring size, to monitor the procedure of transcatheter aortic valve implantation (TAVI), and perform postoperative follow-up. Methods: Eighteen patients with bicuspid valve malformation and severe aortic stenosis bicuspid aortic valve (Group BAV-AS) and 23 patients with a tricuspid valve and severe aortic stenosis trileaflet aortic valve (Group TAV-AS) were enrolled in this study. Preoperative routine transthoracic echocardiographic (TTE) examination and two- and three-dimensional transesophageal echocardiography (2D and 3DTEE) were performed, followed by perioperative 2D and 3D TEE monitoring and postoperative routine TTE at 6-month follow-up. Results: Both BAV-AS and TAV-AS patient groups were successfully implanted with bioprosthetic valves under 3DTEE guidance. Parameters at 6-month postoperatively, including prosthetic valve orifice area, mean aortic transvalvular pressure gradient, and left ventricular ejection fraction, showed significant improvement compared with baseline measures (P < 0.0001) in both the groups. No differences were observed between the groups. The maximum diameter of the aortic annulus and eccentricity index were larger in the BAV-AS group than in the TAV-AS group, whereas the minimum diameter of the aortic annulus was larger in the latter (both P < 0.0001) after TAVI. Moreover, the values of maximum and minimum diameters on 3DTEE were strongly correlated with those on multidetector computed tomography. Conclusions: TEE is capable of clearly displaying the morphology of aortic valves and valve rings and precisely quantifying the size of the aortic annulus, thereby playing an essential role during preoperative and perioperative periods. The postoperative shape of the prosthetic valve ring was more oval (larger than normal eccentricity index) in the BAV-AS group and more circular (smaller than normal eccentricity index) in the TAV-AS group.

Percutaneous left atrial appendage closure through a patent foramen ovale evaluated by intraprocedural transesophageal echocardiography.

A 59-year-old man with persistent atrial fibrillation (AF) and recent ischemic stroke presented to our hospital for evaluation of percutaneous left atrial appendage (LAA) closure. He had suffered from recurrent palpitation for more than 1 year. On admission, his blood pressure was 130/88 mmHg and heart rate was 79 bpm. The level of B-type natriuretic peptide (BNP) was 850.3 pg/ml. Transthoracic echocardiography showed a dilated left atrium with the anteroposterior dimension of 46 mm. The patient refused to accept antithrombotic therapy and chose LAA closure for personal reasons. Pre-procedural two-dimensional and three-dimensional transesophageal echocardiography (TEE) revealed a windsock-shaped LAA with a width of 22 mm and a depth of 23 mm. No evidence of LAA thrombus was detected (Fig. 1a, b). A patent foramen ovale (PFO) with left-toright shunt was noted (Fig. 1c), and was used for left atrial access during percutaneous closure of LAA in this case. Intraprocedural TEE was performed to monitor the delivery of the sheath through PFO (Fig. 1d, e). Angiography results confirmed TEE-measured landing zone diameters (Fig. 1f). A 27-mm WATCHMAN device was implanted. TEE demonstrated a mild residual leak at 130 (Fig. 1g). A 24-mm Amplatzer occluder was deployed to the PFO after LAA closure (Fig. 1h, i). There was no residual interatrial shunt shown by TEE.

New echocardiographic indexes for evaluating cardiac function in idiopathic pulmonary arterial hypertension using three-dimensional echocardiography.

Purpose Noninvasive real-time three-dimensional echocardiography (RT3DE) was utilized to explore new indexes for evaluating cardiac function in patients with idiopathic pulmonary arterial hypertension (IPAH). Methods Parameters of cardiac function were evaluated in 24 patients with IPAH and 24 normal control subjects. End-systolic volume (ESV), enddiastolic volume (EDV), and ejection fractions (EFs) of the right and left ventricles (RV, LV, respectively) were measured using a four-dimensional RV and LV quantification method. Right heart catheterization was performed in IPAH patients within one day of the RT3DE examination to obtain measurements of pulmonary vascular resistance (PVR). A 6-minute walk test (6MWT) was also performed within 48 hours. Results RT3DE showed RV volumes were increased while LV volumes were decreased in IPAH patients as compared to volumes in normal control subjects (P <0.001, respectively). Additionally, the RVEFs in IPAH patients were significantly lower compared to those in control individuals; however, the two groups showed no difference in LVEF. We then termed RVEDV/LVEDV and RVESV/LVESV as “new indexes,” and found both values were higher in IPAH patients compared to control subjects. A linear regression analysis revealed that neither RVEDV nor RVESV, but rather LVEDV and LVESV negatively correlated with PVR and results on the 6MWT. RVEF correlated negatively with PVR. Both “new indexes” showed a significant positive correlation with PVR and 6MWT results. Conclusions Our results suggest that evaluation of biventricular volume and function using RT3DE might be useful for non-invasive assessment of cardiac function in IPAH.