The purpose of this study was to explore the feasibility of dual-source computed tomography (DSCT) high-pitch scan mode in the preoperative evaluation of severe aortic stenosis (AS) referred to transcatheter aortic valve implantation (TAVI). Thirty patients with severe AS referred for TAVI underwent cervico-femoral artery joint DSCT angiography. Measurement and calculation of contrast, contrast noise ratio (CNR) and noise of aorta and access vessels were performed. The intra-and inter-observer reproducibilities for assessing aortic root and access vessels were evaluated. Evaluation of shape and plagues of aorta and access vessels was performed. The contrast, CNR and noise of aorta and access vessels were 348.2~457.9 HU, 12.2~30.3 HU and 19.1~48.1 HU, respectively. There were good intra-and inter-observer reproducibilities in assessing aortic root and access vessels by DSCT (mean difference:-0.73~0.79 mm, r=0.90~0.98, P < 0.001; mean difference:-0.70~0.73 mm, r=0.90~0.96, P < 0.001). In the 30 patients, the diameters of external iliac artery, femeral artery or subclavian artery were less than 7 mm in 5 cases (16.7%), marked calcification in bilateral common iliac arteries in 1 case (3.3%) and marked soft plaque in left common iliac artery in 1 case (3.3%). DSCT high-pitch scan mode was feasible in the preoperative evaluation of aorta and access vessels in patients with AS referred for TAVI.
ObjectiveTo introduce the role of three dementional computed tomograph (3D-CT) for patients underwent transcatheter aortic valve implantation (TAVI) procedure in perioperative evaluation. MethodsFrom April 2014 to June 2015, we retrospectively analyzed clinical data of 28 patients with severe aortic stenosis underwent successful TAVI procedure using new second-generation device, who were enrolled in this study including 12 males and 16 females at mean age of 72.8±4.5 years. We used 3D-CT to get the perioperative relative evaluation, including valve morphology and calcification degree, annular diameter, aoronary ostium height, ascending aorta, aortic sinus diameter, left ventricular-aortic angle, optimal intraoperative angiogram projection angle. Based on the evaluation by 3D-CT image, the prosthesis size, balloon size, best intraoperative imaging projection angle and approach of apex were then chosen. ResultsAll patients with severe aortic stenosis underwent successful TAVI procedure with mean logistic Euro-SCORE I:26.2%±7.9%. CT image revealed that mean aortic annular diameter was 24.6±1.8 mm with mean valve prosthesis size 25.8±1.1 mm and pre-dilation balloon size 23.1±1.2 mm and 76.8% patients were of tricuspid aortic valve with severe calcification and 25% patients were of asymmetric calcification. Optimal intraoperative angiogram image was achieved in 92.9% patients with the help of preoperative CT image. There was a statistic difference in mean transvalvular gradient after valve implantation (54.1±15.3 mm Hg vs. 13.1±8.5 mm Hg, P<0.05). And there was no mortality or severe complication postoperatively. Conclusion3D-CT image palys an important role during perioperative evaluation of TAVI procedure and it can be helpful for Chinese doctors to operate TAVI successfully.
ObjectiveTo investigate different expressions of microRNA-1 (microR-1) microRNA-133(microR-133) microRNA-34a (microR-34a) and their possible target protein Ankyrin-B in right atrial appendage of patients with atrial fibrillation (AF) or sinus rhythm (SR) analyze their correlation,and explore novel mechanisms of the pathogenesis and development of AF in microRNA level. MethodsForty right atrial appendage samples of 40 patients with rheumatic heart disease who underwent heart valve replacement in Xinqiao Hospital,Third Military Medical University were included in this study. All the patients were divided into AF group including 8 males and 12 females with their age of 52.9±5.8 years and SR group including 9 males and 11 females with their age of 52.4±6.2 years. The expression of microR-1,microR-133 and microR-34a were examined with RTQ-PCR (real-time quantitative PCR) and calculated with delta delta Ct method. Different expressions of ankyrin-B between AF and SR group were examined with immunohistochemistry and Western Blotting. ResultsMicroR-1 expression of right atrial appendage of AF group was significantly lower than that of SR group (0.559±0.252 vs. 3.997±1.251,t=-21.455,P=0.000) microR-133 expression of AF group was significantly lower than that of SR group (0.630±0.238 vs. 5.514±1.549,t=24.133,P=0.000) and microR-34a expression of AF group was significantly higher than that of SR group (4.783±2.012 vs. 1.350±0.638,t=12.596,P=0.000). Immunohistochemistry and Western Blotting showed Ankyrin-B expression in right atrial appendage of AF group was significantly lower than that of SR group (0.66±0.45 vs. 1.09±0.42,t=-3.396,P=0.001). ConclusionMicroR-34a may take part in the pathogenesis and development of AF by regulating the expression of Ankyrin-B.