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The aim of this study is to explore the value of transthoracic echocardiography in the diagnosis of eosinophilic myocarditis. The echocardiographic characteristics of nine patients with eosinophilic myocarditis in our hospital between January 2004 and January 2012 were retrospectively reviewed. In our study, four of the nine patients were diagnosed to have small pericardial effusion. The obliteration of the apical cavity was observed in five of the nine patients. There were six patients with both mitral and tricuspid regurgitation, one patient with only mitral regurgitation, and one patient with only tricuspid regurgitation. Transthoracic echocardiography showed that the diameters of the left and right atria were both increased in eight of the nine patients. The diameter of the left ventricle was increased in five patients, and the right ventricular diameter was increased in four patients. The left ventricular ejection fraction was decreased in two of the nine patients. Five of the nine patients had pulmonary hypertension, and one patient had severe pulmonary hypertension. Transthoracic echocardiography is the primary method for the diagnosis of eosinophilic myocarditis and is also useful in follow-up of the disease.

Background Anomalous origin of pulmonary artery (AOPA) from the ascending aorta is a rare but serious congenital cardiac malformation, which frequently involves the right pulmonary artery (RPA). Methods We retrospectively analyzed the echocardiographic characteristics of 9 cases with anomalous origin of the right pulmonary artery from the ascending aorta (AORPA) studied from 2007 to 2014 in our institution. The results were compared with the findings at surgery. Results The corrective surgery was performed in all 9 cases with AORPA. The diagnosis by transthoracic echocardiography (TTE) of 8 cases with AORPA was confirmed at surgery. The coincidence rate for TTE and surgical findings was 88.9%. One case was misdiagnosed as anomalous origin of the left pulmonary artery from the ascending aorta. The anomalous RPA in all cases had a proximal origin from the posterior or lateral part of the ascending aorta in our series. The mean distance from the aortic valve to the site of origin of pulmonary artery was 16.1±6.6mm (range: 7.0mm–24.0mm). The mean diameter of the anomalous pulmonary artery was 9.6±4.5mm (range: 4.5mm–17.0mm). In 4 of 9 (44.5%) cases there were associated aortopulmonary septal defect, intact ventricular septum, patent ductus arteriosus and interruption of aortic arch (Type A), also known as the Berry's syndrome. Other associated cardiovascular abnormalities included patent ductus arteriosus, ventricular septal defect and atrial septal defect. Severe pulmonary arterial hypertension was noted in all cases. Conclusions TTE plays an important role in the non-invasive and accurate diagnosis of AORPA. TTE can clearly display its site of origin and course, as well as other associated malformations and hemodynamic changes. TTE also plays an important role in the preoperative diagnosis of AORPA.

Background Coronary artery fistula (CAF) is a rare congenital anomaly, which is conventionally diagnosed by coronary arteriography; however, the relation of the coronary artery fistulas to other structures, their origin and course may not be always apparent. Methods The echocardiograms of 63 patients with coronary artery fistulas, who had undergone coronary arteriography and/or surgery from June 2002 to December 2012 at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, and the results were compared with findings by coronary arteriography and at surgery. Results Right CAFs were detected in 33 of the 63 patients (52.4%); 11 had drainage to the right atrium, 10 to the right ventricle, 2 to the left ventricle, 9 to the main pulmonary artery, and 1 to the coronary sinus. Left CAFs were detected in 29 patients (46.0%); 6 had drainage to the right atrium, 12 to the right ventricle, 1 to the left atrium, 2 to the left ventricle, 7 to the main pulmonary artery, and 1 to the coronary sinus. One patient (1.6%) had the origin of the fistula in both coronary arteries. The entry point of the fistula was most often a single orifice (96.8%) and rarely multi-orificial (3.2%). 57 patients (90.5%) had isolated coronary fistulas (90.5%); 6 patients (9.5%) had other congenital cardiac malformations. The ultrasonic diagnosis of 60 patients was in line with findings at surgery and/or coronary arteriography. The diagnostic accuracy rate for coronary artery fistula was 95.2%. Preoperative transthoracic echocardiography missed the diagnosis of coronary artery fistula in three patients (4.8%). There is no difference (P>0.05) in diagnostic accuracy between echocardiography and coronary arteriography and/or surgery. Conclusions Transthoracic echocardiography, in comparison with coronary arteriography and/or surgery, is much simpler, easier, less expensive, safer, readily repeatable, and more convenient with equal accuracy, and should be the first-line method for the diagnosis of congenital coronary artery fistula.

Article history: Received 7 August 2013 Accepted 29 August 2013 Available online 7 September 2013 bolysis was more often used in secondary hospitals than in tertiary hospitals (36.8% vs 14.6%, p b 0.01). (II) Percentage usage of medications were: aspirin in 88.0%–98.6%, ACEI/ARB in 60.5%–84.4%, β-blockers in 55.8%–84.4%, LMWH in 54.2%–94.2%, clopidogrel in 14.3%–88.6%, and cholesterol lowering agents (statins) in 51.9%–90.9% (Table 2). (III) Major in-hospital events, death rates and the incidence Acute coronary syndrome (ACS) is comprised of three clinical conditions resulting from an acute imbalance between myocardial oxygen supply and demand: unstable angina, non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI). In the majority of patients, the primary pathology of ACS is either erosion or rupture of an atherosclerotic plaque leading to either subtotal or total occlusion of amajor branch of a coronary artery. A great deal of basic research, clinical investigation and clinical trials has been published in the western literature on various pharmacological and interventional strategies to prevent myocardial cell death during the time of ischemia and subsequent reperfusion [1]. However, no such information is available for China, where one quarter of the world population resides, until very recently [2]. Unfortunately, that report, which was published in Chinese and appeared in a local Chinese medical journal [2], was little known except in China. The purpose of this editorial is to present the highlights of this important report to the international community outside China. For the study, a total of 1307 in-patients with ST-segment elevation ACS from 64 hospitals across China were recruited and a standard questionnaire was used to obtain information about the patients, including demographic data, treatment and in-hospital outcomes. In these patients, the status of application of reperfusion therapy as well as the effect of aspirin, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), β-blockers, low molecular weight heparin (LMWH), clopidogrel and cholesterol lowering agents (principally statins) were analyzed. The results were as follows

Left ventricular aneurysms mainly occur in patients with transmural myocardial infarction caused by left anterior descending coronary artery occlusion. Left ventricular apical aneurysm is rarely found in patients with normal coronary arteriograms, and even rarer in these patients following cardiac operations. We analyzed 37 patients with postoperative left ventricular apical aneurysm, including 1 case from our hospital and 36 cases from the literature; 23 cases (62%) had left ventricular apical true aneurysms and 14 cases (38%) had left ventricular apical pseudoaneurysms, all confirmed at surgery and/or angiography. All cases, with the exception of one, had previously undergone cardiac surgery under cardiopulmonary bypass with apical venting. Although left ventriculography is generally regarded as the gold standard for diagnosis of ventricular aneurysm, echocardiography is an accurate and sensitive method in the evaluation of left ventricular apical aneurysm. Differential diagnosis of left ventricular apical aneurysm includes takotsubo cardiomyopathy, post transapical approach for transcatheter aortic valve implantation, and left ventricular diverticulum.

The arterial switch operation (ASO) is currently the treatment of choice for infants with transposition of the great arteries (TGA). Little is known, however, about the alteration of anatomic left ventricular (LV) torsional mechanics after the operation. This study sought to evaluate LV torsion in patients of transposition of the great arteries with intact ventricular septum (TGA/IVS) using speckle tracking echocardiography.Echocardiographic images were prospectively acquired in 32 infants (age range, 0.5-60 months) who successfully underwent ASO repair at about 1 month of age and in 48 normal controls. They were divided into early and late categories according to the age at the time of the study. The LV peak systolic torsion and systolic twisting and diastolic untwisting velocities were determined by speckle tracking. Mitral inflow velocity obtained by Pulsed-wave Doppler and mitral annular velocities drawn by septal tissue Doppler were also analyzed.Compared with controls, the early postoperative group (TGA1) had significantly higher septal E/e' (P=0.000). In contrast, septal e' velocity (P=0.000), LV peak apical rotation (P=0.01), twist (P=0.02) and peak untwisting velocity (PUV) (P=0.001) were lower in patients than in controls. For the normal younger group (Control1), PUV correlated positively with e' (r=0.68, P0.001). No significant difference in LV twisting and untwisting was noted between the TGA2 and Control2.Two dimensional speckle tracking echocardiography may sensitively detect impaired LV torsional mechanics in patients with TGA/IVS early after ASO, and the impairment of LV relaxation leads to increased LV filling pressure which is consistent with higher E/e'. However, all patients recovered well thereafter and the overall midterm outcome of ASO is satisfactory.

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.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare but potentially fatal complication of infective endocarditis and aortic valve surgery. 149 patients with P-MAIVF, including 7 cases in our hospital and 142 cases from the literatures, were comprehensively analyzed. P-MAIVF is located in the mitral-aortic intervalvular fibrosa area, which communicates with the left ventricular outflow tract. The cavity of P-MAIVF expands during systole and collapses during diastole. Endocarditis and aortic valve surgery are the most frequent causes. Symptoms of endocarditis, chest pain, heart failure, dyspnea, cerebrovascular accidents and systemic embolism are important clinical presentations. The formation of a fistulous tract, coronary artery compression, and rupture into pericardium are important complications. Transesophageal echocardiography is superior to transthoracic echocardiography in identifying P-MAIVF. Surgery is the treatment of choice with P-MAIVF repair and aortic valve replacement.

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In May 2011 Professor Xin-fang Wang (王新房) from Wuhan, China was named the “Father of Modern Echocardiography” by the International Society of Cardiovascular Ultrasound (Fig. 1). In an auspicious ceremony, the certificate was presented to Professor Wang in Wuhan by Dr. Nanda, President of the Society of Cardiovascular Ultrasound (Fig. 2). Although this exciting news was widely and appropriately publicized in China (Fig. 3), it was not well known in the rest of the world. Therefore, I would like to introduce Professor Wang in this editorial as well as the history and evolution of echocardiography in China under Professor Wang's influence.

IntroductIon Studies conducted so far have shown that patients with left ventricular hypertrophy have increased adiponectin levels; however, these studies were performed only in resting condition. objEctIvEs The aim of the study was to compare adiponectin, resistin, and leptin levels (at rest and after exercise) between patients with hypertrophic cardiomyopathy (HCM) and healthy controls. Additionally, we examined potential relationships between the levels of the 3 adipokines and the left ventricular outflow tract (LVOT) gradient both at rest and at peak exercise. PAtIEnts And mEthods We studied 29 patients with HCM (mean age 42.7 ±11.9 years, 16 men and 13 women). The control group included 19 healthy subjects matched for age-, sex-, and the body mass index. After echocardiographic examination in a supine position, all patients were placed in an upright position and treadmill exercise test was performed with simultaneous continuous echocardiographic monitoring of the LVOT gradient. Adiponectin, resistin, and leptin levels were measured immediately prior to exercise in a supine position and at peak exercise in an upright position. rEsuL ts At baseline (at rest), adiponectin levels tended to be increased in patients with HCM (P = 0.09), while resistin and leptin levels were significantly higher in patients with HCM than in healthy controls. In HCM patients, exercise induced an increase in adiponectin (20.74 ±7.95 vs. 22.52 ±8.10 μg/ml, P

Article history: Received 25 April 2014 Accepted 5 May 2014 Available online 9 May 2014 trol interventions in China may need to de-normalize the practice of giving cigarettes as gifts in order to decrease the social acceptability of smoking. In spite of health hazard warnings on the cigarette packs as required by the Ministry of Health [16] and incontrovertible evidence that cigarette smoking is a major cause of death in China [17], a direct

A recent article on Milton, Sutton and Mutton [1] prompted me to write this editorial. Although many know that it was William Dock who originated the term “Sutton's Law” in medicine, few know the circumstances under which this term came about. It might be timely to recapitulate what I wrote in 1999 [2]. Around 1960, a medical student at Yale toiled relentlessly to document the presence of schistosomes in the liver of a young female Puerto Rican patient. Dock, a visiting professor at the time, had suspected the diagnosis of schistosomiasis in this patient and said, just off the top of his head, “Why don't you apply Sutton's Law?” The derivation of the term is as follows: when Willie Sutton, a hold-up man, was being interviewed by newsmen, he was asked why he always robbed banks. Sutton, with some surprise, replied, “Why, that's where themoney is.” [3]. The diagnosis of schistosomiasiswas, indeed, proven by a positive liver biopsy done by the student [4]. That would have been the end of the story except that there had been two Yale physicians on that teaching round, Robert Petersdorf and Paul Beeson, who were working on a phenomenon called FUO, or fever of unknown origin, which had the whole medical profession baffled. A year later, they published their paper on “Fever of Unexplained Origin,” [3] in which Sutton's Law was recounted in a footnote near the end of the article, “We are indebted to Dr. William Dock for the term Sutton's Law. It recommends proceeding immediately to the diagnostic test most likely to provide a diagnosis, and deplores the tendency to carry out a battery of ‘routine’ examinations in conventional sequence....”. Although Dock was the inventor of “Sutton's law,” Sutton himself denied ever saying that [5]. Nevertheless, it remains a useful instrument for teaching medicine. Dock has often been called Osler of the modern day, because of his immense wisdom, independent thought, inquisitive perception, and a sense of humor [2]. As can be seen from one of his postcards to me while visiting the home town of Wenckebach (Fig. 1), he thought nobodywould remember Sutton's Law or its inventor very long. Fred's

Dr. Richard John Bing (Fig. 1) will be 100 years old on October 12, 2009. There are very few physicians, to my knowledge, who remain very active and extraordinarily productive at 100 years of age. Witness the article Dr. Bing wrote on surgery of the young heart and about Drs. William Glenn and Francis Fontan (Fig. 2) that was published earlier this year [1]. There are even fewer physicianswho are asmultitalented as Dr. Bing who is still productive at 100 years of age as a physician, scientist, musician, composer and author of medical and non-medical books, book chapters and articles. Indeed, Dr. Bing is a genius [2]. I will discuss these attributes in more details later on. I do not intend to write a biography on him, because there have been quite a few excellent ones already published [2–4]. What I intend to do in the following few pages is to describe briefly Dr. Bing's achievements — listed in alphabetical order — from my personal knowledge, recollection and research over the years so that your readers may get a glimpse of what this “Renaissance man” [3,4] is really like.

Objectives To observe the motion of pericardium and myocardium in patients with constrictive pericarditis (CP) and normal subjects using two-dimensional (2D) echocardiography and quantitative tissue Doppler imaging (QTDI), and to investigate the value of this echocardiographic approach in the diagnosis of pericardial adhesion in CP. Background The relationship of the motion of pericardium and myocardium in CP has not been investigated by QTDI. Methods The motions of pericardium and myocardium and the difference between them were investigated using 2D echocardiography combined with QTDI technique in 20 patients with CP and 20 age- and sex-matched normal subjects. Systolic peak displacements of pericardium ( D 1 ), outer-layer myocardium ( D 2 ) and inner-layer myocardium ( D 3 ) were measured from quantitative tissue displacement curves. The ratios of ( D 3 – D 2 )/( D 2 – D 1 ) were then calculated. Results In normal subjects, the motion of myocardium was found to be stronger than that of pericardium, but the motions of outer-layer and inner-layer myocardium were virtually identical. However, in patients with CP, the motion of outer-layer myocardium was significantly reduced approaching that of pericardium, while the motion of inner-layer myocardium was stronger than that of outer-layer myocardium. The ratios of ( D 3 – D 2 )/( D 2 – D 1 ) were significantly higher in patients with CP than those in normal subjects (5.0±4.7 vs 0.6±0.7, P Conclusions Obvious differences exist in the motion of pericardium and myocardium between normal subjects and patients with CP; observations of these differences using 2D echocardiography and QTDI provide a new and sensitive method in the diagnosis of pericardial adhesion in CP.

Hypertrophic cardiomyopathy (HCM) is the commonest cause of sudden cardiac death in the young, especially the young athletes, accounting for one third [1]. The fact that young athletes, especially elite athletes, often have enlarged hearts has been known before HCM was described. Tung [2] in China noticed in 1930 a markedly enlarged heart in an otherwise healthy ricksha puller, employed in one of the departments of his hospital, during a routine physical examination. This finding led to the study of 46 healthy ricksha pullers nearly half of whom showed definite cardiac enlargement, which he reported in 1934 [3]. White in his textbook, entitled “Heart Disease” that was published in 1952 [4], described similar findings, which he called the ‘athletic heart’. “It is of considerable interest to note that the hearts of very active animals are much larger than are those of relatively inactive animals of the same size; for example, the heart of the hare is three times as heavy, relative to body weight, as that of the rabbit, while the heart of the racing greyhound is, in proportion to size, the largest mammalian heart of all (Herrmann, 1926). Finally, when animals, such as dogs or rats, are made to exercise strenuously for long periods of time, it is found that eventually their hearts are considerably larger and heavier than those of control animals of the same age and size, and even from the same litter. This is especially true when the strenuous exercise is imposed during the period of rapid growth. There is no indication that such hypertrophy, when it does occur, is harmful. Recent studies indicate that athletes do not suffer early disability or death because of their exercise in youth; in fact the reverse seems to be the case, at least as regards oarsmen (Cooper et al., 1937; Hartley and Llewellyn, 1939). An interesting volume was published by

Although it is well known that Laennec invented the stethoscope, the story of how he invented it is less well known. This article discusses the many theories behind the story as well as the impact of Laennec's discovery on the practice of cardiology in the 21st century.

The ductus arteriosus (DA) is one of the most important vessels of the fetal circulation. A variety of fetal congenital heart disease (CHD) may greatly influence the structure and flow patterns of the DA. This study was to investigate the structural characteristics of the DA and its value in the diagnosis of fetal CHD using fetal echocardiography combined with cardiovascular casting technology.Twenty-six cases of a normal fetus and 20 cases of a fetus with CHD (10 cases of right-sided obstructive CHD and 10 cases of left-sided obstructive CHD) were enrolled in this study. The three-vessel view and the long axis view of the DA arch were chosen to observe the fetal DA. The diameters of the ascending aorta (AO) and the pulmonary artery trunk (PA) were measured on the left ventricular outflow tract view and the three-vessel view separately, and AO/DA and PA/DA values were calculated separately. The flow direction of the DA was recorded, and the blood flow peak velocity was measured using color and spectral Doppler technology. Cardiovascular cast specimens were made for fetuses secured from induced labor to facilitate further observations of the true form and connections of the DA. At the same time, heart and great vessel deformities were also recorded through careful observation of the cardiovascular cast.The following DA anomalies were observed: ① abnormal diameter (6 cases of stenosis and 9 cases of dilatation); ② abnormal blood flow direction (reverse flow in 5 cases); ③ abnormal blood flow speed (12 cases); ④ abnormal connection site (right-sided DA in 2 cases and a DA connection between the left pulmonary artery and the left subclavian artery in one case); and ⑤ absence of the DA in 2 cases. Compared with the control group, the DA diameter in the right-sided obstructive group was obviously narrowed; by contrast, the diameter of the DA in the left-sided obstructive group was obviously dilated. These differences were statistically significant (p0.05). Compared with the control group, the AO/DA values in the right- and left-sided obstructive groups were significantly increased and decreased, respectively. Finally, relative to the control group, the PA/DA values of the right- and left-sided obstructive groups were significantly reduced.DA enlargement was often associated with left-sided obstructive CHD, whereas a small DA and reverse blood flow often indicated the presence of right-sided obstructive CHD. DA connections can manifest with multiple anatomical variations. During fetal echocardiography, evaluation of the DA is very important; such analyses may help search for associated cardiac defects whenever a diagnosis of CHD is made.

Tea is one of the most widely consumed beverages in the world, next only to water. It can be categorized into three types, depending on the level of fermentation, i.e., green (unfermented), oolong (partially fermented) and black (fermented) tea. In general, green tea has been found to be superior to black tea in terms of antioxidant activity owing to the higher content of (-)-epigallocatechin gallate. The processes used in the manufacture of black tea are known to decrease levels of the monometric catechins to a much greater extent than the less severe conditions applied to other teas. The cardioprotective effect of flavonoids from green tea can be attributed to not only antioxidant, antithrombogenic and anti-inflammatory properties but also improvement of coronary flow velocity reserve. In this article, I will discuss the effects of green tea on atherosclerosis, coronary heart disease, hypertension, diabetes, metabolic syndrome and obesity, and, finally, its comparison with black tea.

The purpose of this study was to explore whether dysglycemia, and/or an increased body mass index, and/or an increased waist/hip ratio increased the risk of hypertension in a lean population of South China. The association among dysglycemia, obesity, and hypertension has been well documented in Western populations. A stratified cluster sampling method was used according to the National Diabetes Mellitus Epidemiology Survey Program in 1998. Blood pressure, fasting plasma glucose, and plasma glucose were measured 2 hours after 75-g oral glucose consumption using the enzymatic method in the morning. Body height, weight, and waist and hip measurements were also collected for the survey. The criteria for the diagnosis of hypertension and diabetes mellitus, including impaired glucose tolerance (IGT), were those published by the World Health Organization in 1999. A total of 11,402 participants were included in the investigation (5,195 men and 6,207 women; age 20 to 74 years). A total of 1,775 cases of hypertension were confirmed in the survey. The prevalence of hypertension was significantly higher in those with diabetes mellitus than in those with a normal blood glucose level, in those with IGT than in those with normal glucose tolerance test findings, and in obese participants than in those with a normal weight (45.5% vs 14.4%, 32.2% vs 14.5%, and 20.6% vs 12.1%, respectively). Multiple logistic regression analysis indicated that age and gender-adjusted odds ratio of hypertension was 2.24 (95% confidence interval 1.88 to 2.68) with IGT compared with those without IGT. The odds ratio for hypertension associated with an increased body mass index and waist/hip ratio was 1.19 (95% confidence interval 1.17 to 1.21) and 1.08 (95% confidence interval 1.07 to 1.09), respectively. In conclusion, the data from an epidemiologic study in South China demonstrated that dysglycemia and increased body mass index and/or waist/hip ratio increase the risk of hypertension even in a lean Chinese population.

Real-time 3-dimensional echocardiography (RT3DE) is a new imaging technique that can provide accurate, important, and additional information concerning cardiovascular morphology, pathology, and function. This article will review the development of the technology of RT3DE and its clinical application. As the technique continues to evolve, RT3DE is bound to play an increasingly important role in the diagnosis, prognosis, and treatment of patients with various forms of cardiovascular disease.

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.

Since the founding of the People’s Republic of China in 1949, many changes have taken place in China over the past half century. Whereas China has made phenomenal strides both economically and geopolitically, it has also undergone dramatic changes in the prevalence of coronary heart disease (CHD). People in China used to be known for their lean body build, low plasma cholesterol levels and low incidence of CHD [1]. Now all has changed; CHD in China has climbed from the fifth most common form of heart disease in 1949–1957 (6%) to the second most common in 1958–1968 (16%) and rising again in 1969–1979 (26%) to become the most common in 1980–1989 (27%) where it remains until today [1]. What are the risk factors responsible for this drastic change in modern China?

Switzerland is a small country in the heart of Europe and well known worldwide for its Alps, foreign bank accounts, cheese, chocolate and watches. However, it also has made a significant contribution to cardiology, especially interventional cardiology. It was where balloon angioplasty and stenting of obstructed coronary arteries, two of the most stunning advances in cardiology in the last 30 years and the two most frequently performed interventional procedures in cardiology, originated. The author, who recently served as a visiting professor in the University of Geneva, University of Bern and University of Zurich, summarized his personal observations and impressions in this report.

Cardiology in China has shown significant changes in the last decade or so. Interventional cardiology, in particular, has shown remarkable advances, especially in the management of coronary artery disease, which, unfortunately, has shown a disconcerting increase in incidence in a country traditionally known for very low incidence of coronary artery disease. Important contributing factors include increasing affluence, westernization of dietary habit and lifestyle, and rampant cigarette smoking. At present, the Chinese population has an annual coronary mortality of one sixth of that reported in the West, an incidence of acute myocardial infarction of one tenth to one eighth, and a mortality of acute myocardial infarction of one eighth. The prevalence of coronary artery disease among the general Chinese population (3–7%) is roughly one quarter of that among the Caucasians in the West, but this will get worse for sure. China still has a lot of catching up to do to reach full modernization. There is a price that every developing country must pay for modernization. However, let the price the Chinese pay not exceed the benefits derived from modernization. Can we achieve a utopian stage in the 21st century in which the modern Chinese retain their ancestral low rates of coronary artery disease while adapting the positive aspects of a modern western lifestyle?

Background : Percutaneous transluminal septal myocardial ablation (PTSMA) has been introduced as an alternative treatment for hypertrophic obstructive cardiomyopathy (HOCM). We report on the acute, short- and long-term results of our experiences in 119 patients from a single center in China. Methods and results : PTSMA was performed in 119 patients with symptomatic HOCM (mean age 35.4±14.8 years, male 80, female 39). All patients had echocardiography performed prior to the procedure, 2-week post-PTSMA, and 6-month post-PTSMA, and 65 patients had echocardiography repeated at 2-year follow-up. The average left ventricular outflow tract (LVOT) gradient was 67.3±7.8 mm Hg before the procedure, and 15.9±6.8 mm Hg after the procedure ( p p p Conclusions : PTSMA is a promising non-surgical procedure for symptomatic patients with HOCM because of its low risk and its significant hemodynamic, echocardiographic and clinical improvement. The significant therapeutic remodeling period was up to 6 months rather than 2 years following the procedure.

To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M-mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M-mode DTI revealed that the activation in mid-interventricular septum was earlier than that in mid-left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal-posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid-left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non-invasively.

Fig. 1. A child, fully awake and comfortable, undergoing open heart surgery for repair of a congenital ventricular septal defect under acupuncture anesthesia in a hospital in Shanghai, photographed by the author during his 1972 visit to China. The word acupuncture combines the Latin acus (needle) and punctum (a prick) [1,2]. From the historical record of Huangdi Neijin (the Yellow Emperor's Classic), acupuncture has been used in China as a therapeutic tool for at least 2000 years [3]. Soldiers noted, after being wounded by arrows, that their pain often eased for quite a while. Therefore, a cause-and-effect relationship was assumed between the arrow wound and the unexpected diminution of pain. However, it has been little known in theWestern world until the early 1970s following U.S. President Nixon's historic visit to China in 1972 [4]. Acupuncture becomes one of the most popular treatments in alternative medicine and accounts for more than 10 million treatments given annually in the United States [5]. Much interest was further engendered by tales by subsequent visitors to China who witnessed surgical operations being successfully performed on conscious patients under acupuncture anesthesia [6–15]. Skeptics who deny that acupuncture anesthesia can work have suggested that acupuncture is nothing more than an effective use of hypnosis or autosuggestion. I was also a skeptic until I witnessed with myowneyes several operative procedures performedonpatients under acupuncture anesthesia including those with congenital (Fig. 1) and acquired valvular (Fig. 2) heart diseases. Being a native-born Chinese, I was able to communicate directly with the patients, without going through any interpreters, to find out what discomfort and if any pain they actually might experience during the procedures. Of course, I was not the only physician who was impressed by cardiac surgery under acupuncture anesthesia. Other well-known surgeons around theworld, such as DeBakey from the United States [16], Hollinger et al. [17] from Germany, and Caracausi from Italy [18] were too.

Background Published correlations between histological abnormalities and right ventricular (RV) function, as evaluated by speckle tracking echocardiography (STE), are scarce in patients with tetralogy of Fallot (TOF). The purpose of the study is to assess age-associated differences in the effect of RV myocardial remodeling on ventricular function in patients with TOF. Methods Operatively resected crista supraventricularis muscle from 30 patients (median age 12months) undergoing intracardiac repair of TOF were studied by light microscopy. The patients were divided into younger (age at surgery ≤12months) and older (age at surgery >12months) subgroups. The RV global longitudinal peak systolic strain (GLS), strain rate (GLSRs) and early diastolic strain rate (GLSRe) were measured by two-dimensional STE before and 6months after repair. Results The histopathological data revealed hypertrophy of the cardiomyocytes, a thickened endocardium, and increased interstitial and perivascular collagen in RV, which were associated with older age at the time of repair. The RV global systolic and diastolic functions in patients with repaired TOF were increased compared with the preoperative values. The RV cardiomyocyte diameter and collagen volume fraction (CVF) correlated with the preoperative GLS, GLSRs and GLSRe, respectively, in the younger patients (r 1 =−0.566, P 1 =0.018; r 2 =−0.493, P 2 =0.004; r 3 =−0.504, P 3 =0.039). The RV cardiomyocyte diameter and CVF correlated with preoperative GLS, GLSRs and GLSRe, respectively, in the older patients (r 1 =−737, P 1 =0.004; r 2 =−0.588, P 2 =0.035; r 3 =−0.812, P 3 =0.001). The correlation of the RV cardiomyocyte diameter with the postoperative GLS and GLSRe (r 1 =−665, P 1 =0.036; r 2 =−0.787, P 2 =0.007) and the CVF with the postoperative GLSRs and GLSRe (r 1 =−762, P 1 =0.002; r 2 =−0.713, P 2 =0.004) were identified only in the older patients. Multivariate analysis indicated that the age at repair was an independent predictor of postoperative GLSRs and GLSRe in all of the patients (β=−0.449, P=0.041; β=−0.607, P=0.004). Conclusions The effect of RV myocardial remodeling on preoperative RV function was more pronounced in the older patients with TOF than in the younger ones. Preoperative myocardial remodeling affected the postoperative RV function in the older but not in the younger patients. The age at the time of surgical repair was the independent determinant of the postoperative RV myocardial function.

(Semi) supine exercise testing has an established role in the evaluation of patients with valvular heart disease and can help clinical decision making. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. However, exercise-induced changes in valve hemodynamics, left ventricular outflow obstruction and pulmonary artery pressure depended on load variation. Changing position from supine to upright rapidly decreases load conditions for the ventricles. Therefore several cardiac centers have proposed exercise stress echocardiography in the upright position with gradient monitoring sometimes also in post-exercise recovery. Doppler measurement of subaortic gradient has been a very helpful and informative examination in several heart diseases (especially in hypertrophic cardiomyopathy, valve heart diseases, prosthesis dysfunction).

Background Hypertrophic cardiomyopathy (HCM) and left ventricular noncompaction (LVNC) are both genetically determined and familial diseases that possess variable but overlapping genetic defects. Previous literature has mostly reported their occurrences as either separate disorders in different members of a family or coexisting entities in sporadic cases rather than familial cases. This study explored the echocardiographic diagnostic values and familial features in a family with coexistence of HCM and LVNC. Methods A four-generation family comprised of 30 members was studied; 28 members underwent familial screening by routine transthoracic echocardiography (TTE), contrast echocardiography (CE), and/or cardiac magnetic resonance imaging (cMRI). Echocardiographic and cMRI findings were then compared. Results Four members (13.3%) died of sudden death or heart failure. Eleven members (39%) suffered from HCM, LVNC or both. There were 13 left ventricular hypertrophic segments among the echocardiographic images of 9 locally archived patients, including septal, inferior and anterior wall segments (8, 3, 2 respectively) as well as 20 noncompaction segments, including lateral, apical, anterior, antero-septal and inferior wall segments (8, 5, 4, 2, 1 respectively). Left atrial dilatation and diastolic dysfunction were significant in these subjects. Findings from TTE and CE were in accordance with those from cMRI in lesion locations. CE provided more information about noncompaction segments located in the antero-septum and near field than TTE. Conclusions HCM and LVNC coexist in one Chinese family, with overlapping phenotypes and different ages, clinical manifestations and multimodality imaging findings. TTE is an excellent tool to diagnose HCM and LVNC with supplementation by CE.

Background Although Hippocrates has been traditionally recognized worldwide as the father of medicine, the fact that he was seminal in the development of cardiology is much less well appreciated. Therefore his role in forming the foundation of scientific practice of cardiology needs to be defined. Methods This article was based on a personal 3-day visit in 1999 to the island of Kos, the birthplace of Hippocrates, and further research on the subject on return to the United States. Results Considering the fact that all the references to the heart and diseases of the heart were recorded almost 2500 years ago at a time when knowledge of anatomy was fragmentary and pathophysiology practically nonexistent, Hippocrates had truly accomplished a remarkable task in describing the various disorders of the heart and blood vessels, defining the methods of diagnosis and treatment, and outlining the prognostic factors and preventive measures. Conclusions Hippocrates was the pioneer in carefully documenting and thoughtfully interpreting case studies, an essential prerequisite to the coupling of clinical, physiologic, and pathologic features of diseases in the practice of cardiology that characterized the beginning of modern scientific medicine in the Renaissance. (Am Heart J 2001;141:173-83.)

The birth of therapeutic balloon dilation in the management of cardiovascular disease can be traced to Rashkind who in 1966 developed balloon atrial septostomy for palliation of patients with complete transposition of the great vessels. Actually, Dotter and Judkins anteceded Rashkind by coaxial sequential dilation of iliofemoral atherosclerotic obstruction in 1964. However, it was not until the development by Gruntzig in 1978 of a miniaturized flexible balloon catheter for percutaneous transluminal coronary angioplasty that therapeutic balloon dilation began to be applied to stenotic heart valves. The development of percutaneous balloon valvuloplasty was the natural consequence of the early success of surgical mechanical dilation of stenotic heart valves; first the pulmonic valve, then the mitral valve, and finally the aortic valve. The successful relief of valvular stenosis by percutaneous balloon valvuloplasty is a remarkable example of how the pioneering cardiac surgeons paved the way for interventional cardiologists to take over the treatment of heretofore, surgically managed diseases.