Jiancheng Han

Myxoma of the Left Ventricular Outflow Tract

Cardiac myxomas are uncommon tumors found in 0.5 per million population per year. 1 Furthermore, a myxoma found in the left ventricular outflow tract is rare. This is a report of such a tumor, with surgical and pathologic confirmation of the echocardiographic diagnosis.

Application of spatio-temporal image correlation technology in the diagnosis of fetal cardiac abnormalities

Congenital heart disease is the birth defect with the highest incidence in China. Its timely and accurate prenatal diagnosis is critical for appropriate perinatal and postnatal management and salvage treatment. With improvements in the diagnostic capabilities of ultrasound and clinical manipulation techniques, prenatal diagnosis is conducted increasingly early and with greater accuracy. However, the representations of tiny blood vessels and the determination of abnormal spatial structures in the fetal period continue to cause difficulties in prenatal diagnosis. In theory, spatio-temporal image correlation (STIC) technology is able to compensate for the defects of previous traditional two-dimensional (2D) ultrasound and improve the diagnostic accuracy. The aim of the present study was to investigate the clinical application value of STIC technology combined with traditional 2D ultrasound in the diagnosis of fetal cardiac abnormalities. A total of 1,286 fetuses were subjected to sequential echocardiographic examination, during which STIC technology was used to collect heart volume data and carry out image post-processing and off-line analysis. In addition, the prenatal and postnatal echocardiography results were compared with the pathology results following the induced labor of fetuses with cardiac abnormalities. The sensitivity, specificity, misdiagnosis rate and rate of missed diagnosis for the STIC technology in the diagnosis of prenatal fetal cardiac abnormalities were 97.4, 99.6, 0.4 and 2.6%, respectively. The total coincidence rate was 99.2% and the positive and negative predictive values were 97.9 and 99.4%, respectively; the statistics for the consistency check of the STIC technology in the diagnosis of fetal cardiac abnormalities are κ=0.991, P=0.000. STIC technology combined with fetal echocardiography may be used for the definite diagnosis of fetal heart malformations, with high sensitivity and specificity.

Echocardiographic Determination of the Prevalence of Primary Myxomatous Degeneration of the Cardiac Valves

BACKGROUND There is a paucity of data on the prevalence of primary myxomatous degeneration (PMD) of the cardiac valves. Because the gold standard for the diagnosis is pathology, its preoperative detection rate is relatively low. The purposes of this study were to determine the capability of echocardiography to identify PMD compared with surgical pathological findings and to determine the echocardiographic features of PMD. METHODS Echocardiograms were retrospectively compared with pathologic findings in 1,080 patients undergoing surgery for moderate or severe cardiac valve regurgitation. PMD of the mitral, aortic, and tricuspid valves was retrospectively identified, with a comparison of the echocardiographic and pathologic findings, to estimate the prevalence of PMD and to summarize its echocardiographic features. RESULTS Of 1,080 patients, 104 were diagnosed with PMD (prevalence, 9.62%). Echocardiography identified valvular prolapse and thickening in 85% of patients. The echocardiographic characteristics of PMD included valvular regurgitation, valvular thickening, valvular prolapse, and rupture of chordae tendineae. Combinations of these characteristics were seen on multiple valves. Among patients with PMD, 59 had only mitral valve involvement, 25 had only aortic valve involvement, two had only tricuspid valve involvement, 10 had both mitral and aortic valve involvement, and three had both mitral and tricuspid valve involvement. CONCLUSIONS In patients undergoing surgery for valvular regurgitation, a high prevalence of PMD was found. PMD has distinctive echocardiographic features, suggesting its preoperative diagnosis.

Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa in a Patient After Radio Frequency Catheter Ablation of Atrial Fibrillation

Received September 8, 2008, from the Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (J.H., Y.H., Z.L., J.C., X.G., J.P., J.X.); and Pauley Heart Center, VCU Health System, Virginia Commonwealth University, Richmond, Virginia USA (J.V.N., M.C.K.). Revision requested September 25, 2008. Revised manuscript accepted for publication October 28, 2008. Address correspondence to Zhian Li, MD, Beijing Anzhen Hospital, 2 Anzhenli, Chaoyang District, 100029 Beijing, China. E-mail: lizhian_anzhen@yahoo.com.cn Abbreviations MAIVF, mitral-aortic intervalvular fibrosa; 3D, 3-dimensional; TTE, transthoracic echocardiography Case Report

Isolated Double-Orifice Mitral Valve Anomaly on 3-Dimensional Transesophageal Echocardiography

A double-orifice mitral valve (DOMV) is an uncommon congenital mitral valve anomaly and is often associated with other congenital heart defects, in particular, atrioventricular septal defects. 1 The isolated occurrence of this anomaly is very rare. Most of cases can be diagnosed by 2-dimensional echocardiography. Three-dimensional (3D) echocardiography provides a more detailed analysis of both the structure and function of the mitral valve and congenital mitral anomalies. 2 - 4 This report describes an isolated DOMV identified by 3-dimensional transesophageal echocardiography (3D-TEE), which to our knowledge has not previously been described using this technology.

Fetal retroesophageal left brachiocephalic vein with U‐shaped vascular ring on four‐dimensional color Doppler ultrasound

Retroesophageal or retrotracheal left brachiocephalic vein (LBCV) is a very rare anomaly, first described by Yigit et al.1 Subsequently, a study was conducted using computed tomography to examine LBCV in children,2 and a case of fetal retrotracheal LBCV with a complex cardiac anomaly has been reported.3 In addition, the prenatal evaluation of fetal LBCV and the normal reference ranges for LBCV have been established.4.

Echocardiographic versus Histologic Findings in Marfan Syndrome

This retrospective study attempted to establish the prevalence of multiple-valve involvement in Marfan syndrome and to compare echocardiographic with histopathologic findings in Marfan patients undergoing valvular or aortic surgery. We reviewed echocardiograms of 73 Marfan patients who underwent cardiovascular surgery from January 2004 through October 2009. Tissue histology was available for comparison in 29 patients. Among the 73 patients, 66 underwent aortic valve replacement or the Bentall procedure. Histologic findings were available in 29 patients, all of whom had myxomatous degeneration. Of 63 patients with moderate or severe aortic regurgitation as determined by echocardiography, 4 had thickened aortic valves. The echocardiographic findings in 18 patients with mitral involvement included mitral prolapse in 15. Of 11 patients with moderate or severe mitral regurgitation as determined by echocardiography, 4 underwent mitral valve repair and 7 mitral valve replacement. Histologic findings among mitral valve replacement patients showed thickened valve tissue and myxomatous degeneration. Tricuspid involvement was seen echocardiographically in 8 patients, all of whom had tricuspid prolapse. Two patients had severe tricuspid regurgitation, and both underwent repair. Both mitral and tricuspid involvement were seen echocardiographically in 7 patients. Among the 73 patients undergoing cardiac surgery for Marfan syndrome, 66 had moderate or severe aortic regurgitation, although their valves manifested few histologic changes. Eighteen patients had mitral involvement (moderate or severe mitral regurgitation, prolapse, or both), and 8 had tricuspid involvement. Mitral valves were most frequently found to have histologic changes, but the tricuspid valve was invariably involved.

Diagnostic value of an ROC curve of the size of the antepartum foramen ovale in the prediction of puerperal atrial septal defect

The aim of this study was to determine the diagnostic value of an ROC curve of the antepartum foramen ovale (AFO) size and the ratio of FO size to aorta (AO) size (FO/AO) for the prediction of puerperal atrial septal defect in different gestational weeks (DGWs). A total of 958 cases were divided into five groups according to number of gestational weeks. Comparisons of FO size, AO size and FO/AO were determined by variance analysis. The correlations between FO size, AO size and gestational age were determined using regression analysis and comparisons between atrial septal defect (ASD) diagnosed in DGWs and normal cardiac FO size and FO/AO were analyzed by t-test. ROC curve analysis was used for FO size and FO/AO to predict the demarcation point of puerperal ASD (pASD). The differences between FO size and AO size in the five groups at DGWs were statistically significant (P=0.000). The sizes of FO and AO increased with gestational age. The differences among pASD, normal cardiac FO size and FO/AO were statistically significant (P=0.000). FO size in the five DGW groups (18–22, 23–26, 27–30, 31–34 and 35–40 weeks) was able to predict the demarcation points of pASD, which were 5.02, 5.15, 6.55, 8.55 and 7.90 mm, respectively. The prediction of pASD with AFO size and FO/AO was accurate and may provide reliable reference values in the clinic.

Parachute mitral valve accompanied by bicuspid aortic valve on three-dimensional transesophageal echocardiography

We report the findings of three‐dimensional (3D) transesophageal echocardiography (TEE) in a patient with a parachute mitral valve (MV) accompanied by aortic valve (AV) malformation. The results indicated an enhanced echo in MV anterior leaves, incrassate, and shortened subvalvular chordae tendineae, and posteromedial papillary muscle that had echo reinforcement, calcification, retroposition, and a significant decrease compared with anterolateral papillary muscle. In addition, the anterolateral papillary muscle was huge, with the bilateral papillary muscles fused partly, and the posterior subvalvular chordae tendineae incrassate, shortened, and attached parachute‐like to the anterolateral papillary muscle. The MV appeared dome‐shaped for the open limit in diastole with an MV area of 1.6 cm. Moreover, the left ventricle increased in size and the bicuspid AV was malformed. Continuous wave Doppler angiograph showed that the flow rate increased to 398 cm/seconds at the AV orifice area. A 3D form of the MV structure was observed from the left ventricle using 3D‐TEE inspection. The anterolateral papillary muscle was fused with its posteromedial homologue. The chordae tendineae was attached to the anterolateral papillary with the parachute‐like structure, indicating dome movement.

Prenatal Diagnosis of Bilateral Ductus Arteriosi and an Anomalous Origin of the Right Pulmonary Artery From the Right-Sided Duct: Clinical Letters

Bilateral ductus arteriosi (DAs) with an anomalous origin of the right pulmonary artery (PA) are rare and usually present with heart failure and pulmonary hypertension in early infancy. We report a case of bilateral DAs with an anomalous origin of the right PA from the right DA that was diagnosed on fetal echocardiography and confirmed via vascular casting. A 31-year-old primigravid Chinese woman was referred to our maternal-fetal unit at a gestational age of 22 weeks 2 days with a suspected anomalous origin of the right PA from the ascending aorta. There was no medication use during pregnancy. The cell-free fetal DNA test suggested a low risk of aneuploidy. An ultrasound examination showed normal fetal growth and no hydrops fetalis or other organ anomalies. A fetal echocardiographic examination revealed unremarkable atrioventricular valves and semivalves, an intact ventricular septum, and a normal primary atrial septum and foramen flap. The left PA was contiguous with the main PA, and no confluence was noted with the right PA (Figure 1A). The aortic arch was on the left, and the left DA appeared normal. A transverse view of the aortic arch showed an anomalous vessel originating from the right side of the aortic arch, and spectral Doppler imaging confirmed that it was the PA. From a long-axis view,