"TAVR practitioners understand images" - the second semi-final of the third AP-SHD "flap" image accompanying reading contest was successfully concluded in Shenzhen!

"On December 16, 2023, during the Lingnan Valve Conference, the third AP-SHD" Valve "Image Reading Contest · Semi final Game 2 kicked off in Shenzhen! On this high-level competitive academic stage, the six outstanding contestants who have stood out from the past fierce academic competitions will fight head-on with the heroism of the players and challenge their qualification for the finals! "The war drums are roaring and the thunder is shaking the sky, and the battle field is as vigorous as a rainbow". In this semi-final battle, what kind of wonderful case display will each contestant rely on to ignite the collision spark of academic competition? What kind of sharp comments will you give? Which players can stand out from them? Let's review this wonderful event with us and reveal the answers to these questions!

Professor Luo Jianfang from Guangdong Provincial People's Hospital and Professor Wu Yongjian from Fuwai Hospital of the Chinese Academy of Medical Sciences are specially invited to serve as the chairman of the second semi-final; Professor Feng Yuan of West China Hospital of Sichuan University, Professor Jiang Zhengming of Beijing Anzhen Hospital affiliated to Capital Medical University, Professor Li Jie of Guangdong Provincial People's Hospital, Professor Liu Xianbao of the Second Affiliated Hospital of Zhejiang University School of Medicine, Professor Song Guangyuan of Beijing Anzhen Hospital affiliated to Capital Medical University, and Professor Xu Kai of the General Hospital of the Northern Warzone served as the general planner of the competition; Professor Chen Lianglong of the Union Medical College Hospital affiliated to Fujian Medical University, Professor Fang Jun of the Union Medical College Hospital affiliated to Fujian Medical University, Professor Fang Zhenfei of the Second Xiangya Hospital of Central South University, Professor Gong Ren of the Second Affiliated Hospital of Nanchang University, Professor Jiang Xiaofei of Zhuhai People's Hospital, Professor Li Yan of the Tangdu Hospital affiliated to the Air Force Military Medical University, Professor Liu Yang of the Xijing Hospital of the Air Force Military Medical University Professor Liu Changfu from the General Hospital of the Chinese People's Liberation Army, Professor Pan Wenzhi from Zhongshan Hospital affiliated to Fudan University, Professor Jiancheng from Southern Medical University, and Professor Zhu Zhengbin from Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine served as expert judges; Professor Chen Guojun of Nanfang Hospital of Southern Medical University, Professor Du Run of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Professor Li Jiale of Hong Kong Prince of Wales Hospital, Professor Nie Ruqiong of Sun Yat sen Memorial Hospital, Professor Qiao Fan of Shanghai Changhai Hospital, Professor Wang Moyang of Fuwai Hospital of Chinese Academy of Medical Sciences, Professor Wang Yubin of Xuanwu Hospital of Capital Medical University Professor Zeng Qingchun from Southern Hospital of Southern Medical University, Professor Zhang Hongliang from Fuwai Hospital of Chinese Academy of Medical Sciences, and Professor Zhuang Xiaodong from the First Affiliated Hospital of Sun Yat sen University served as the on-site jury; Professor Xu Jizhe from the First Hospital of Lanzhou University, Professor Zhong Yucheng from the Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, Professor Zhao Zhengang from West China Hospital of Sichuan University, and Professor Chen Tao from the General Hospital of the Chinese People's Liberation Army served as regional coaches; Professor Zhang Longyan from Wuhan Yaxin General Hospital and Professor Niu Guannan from Fuwai Hospital, Chinese Academy of Medical Sciences acted as the compere of the competition. (Sort by Last Name Pinyin)

Forge ahead | Gather medical wisdom and experience to nurture the backbone in the field of valve intervention

"Petal" shadow accompanying 2023 picture reading contest

Professor Feng Yuan: Build an academic exchange and competitive platform to help improve the image reading ability of the artists

As an important event in the field of national structural heart disease, the "valve" image accompanying image reading contest has attracted the active participation and attention of many young talents and well-known experts. As this competition has become more and more intense, the six outstanding players who broke out of the tight encirclement of academic competition are even more eager to make a final push for the final place to be qualified for the finals! In the next competition, I hope that the contestants can put down their burdens, go to the battle light, and compete to the best of their ability, style, harvest and worth the trip. I also hope that the judges and experts can share more experience, unreservedly provide accurate surgery and imaging guidance for the contestants, and jointly help the development of valve intervention in China to a higher level!

Professor Li Yan: to facilitate the academic exchange of Dahang and provide opportunities for promoting the standardized development of valve intervention

The holding of the "valve" shadow accompanying image reading contest has facilitated the academic exchange of clinical operators in the field of valvular heart disease in China, and provided an opportunity to promote the development of more efficient and standardized valve intervention. Each event will not only benefit the contestants, but also benefit the judges and experts or members of the audience from the intense case discussion, from which they can learn new insights and inspiration. Sincerely thank all the judges and experts for their participation. They are the best in our industry. At the same time, sincerely wish all the contestants can play their best and achieve outstanding results in today's competition!

Professor Pan Wenzhi: Show your best demeanor and fully display your extraordinary spirit

Today, the second round of the semi-final of the third AP-SHD "valve" image accompanying image reading contest is coming. This activity not only provides an important platform for young and middle-aged cardiac valve interventional physicians to demonstrate their TAVR image reading ability, but also injects a strong impetus into the further development of China's structural heart disease field! The venue was full, the atmosphere was in full swing, full of competitive passion. It is expected that in the next contest, all contestants will be able to compete fiercely around the wonderful TAVR cases, fully demonstrate their strong practical ability of TAVR, and show their best demeanor!

Following the earnest messages from the famous scholars, the conference host invited the representatives of the teams in the North China Division and the Northwest Division to issue the team declaration in turn! Then, the scene of the competition was filled with passionate music. Professor Song Guangyuan and Professor Li Jie, two specially invited guests, came on the stage together, with hammers in hand, and struck the gong in unison, officially opening the second semi-final of the third AP-SHD "petal" image accompanying reading contest. "The drums are stirring up the thunder, and the warriors are more energetic than the rainbow". It is expected that in the next competition, all the contestants will be able to compete in style and level, fully demonstrate the excellent potential of the young and middle-aged generation of Chinese artists in the field of TAVR, and work together with expert judges to create a highly accurate image reading contest.

ROUND 1 - [Team Battle] Strive with "Heart"

"Petal" shadow accompanying 2023 picture reading contest

Professor Li Jiale

Professor Liu Xianbao

The competition highlights the case image evaluation analysis and strategy formulation display. In this link, three players from North China and Northwest China made concerted efforts to carry out a comprehensive and systematic preoperative assessment of different types of cases, including annular diameter, calcification distribution, coronary artery occlusion risk, access conditions and other aspects, combined with CT images. At the same time, the surgical strategies formulated by their teams were introduced in detail. After the contestant's report, the contestants, the coaching team and the on-site expert judges in the other competition area can put forward professional questions around the case and conduct in-depth academic discussions with each other. After that, Professor Li Jiale and Professor Liu Xianbao revealed the true clinical operation of the two central cases displayed in this link and shared their practical experience of the central team.

North China Division Team - Image Analysis and Strategy Development of "Severe AR and Moderate Severe AS"

Doctor Feng Dejing

Doctor Chen Yang

Doctor Yi Tieci

The patient was a 74 year old male, who was diagnosed with severe AR and moderate to severe AS by ultrasound, accompanied by multiple complications such as lung and pleural lesions, hypertension, hyperlipidemia, cerebral infarction, atrial fibrillation, and brain degeneration. LVEF was 50%, which was a surgical high-risk patient. TAVR was considered as the first choice. In view of the poor lung condition of the patient and the history of atrial fibrillation, cerebral infarction and brain degeneration, local anesthesia+sedation should be considered. Combined with the CT evaluation results, the patient is a type 1 bicuspid valve with severe calcification and left right fusion. During the operation, 22-23 mm balloons can be considered for pre expansion. Whether to expand backward can be comprehensively analyzed according to the postoperative pressure difference and valve shape. If the pressure difference is ideal and the valve shape is acceptable, it can not be expanded backward to avoid tearing. As for the mechanism of aortic valve regurgitation, considering that it is related to the membranous aneurysm channel and the poor movement of the valve lobe, it is recommended to select a self expanding valve with a skirt and release it under the valve, so that the skirt can close to the outflow channel to seal the regurgitation from the membranous aneurysm channel; During the operation, the guide wire should be alert to enter the ventricle from the membranous tumor channel, and the transvalvular channel can be confirmed by combining fluoroscopy and ultrasound. In addition, the bilateral lumen of the patient is OK, but the calcification of the right front wall is heavy, which poses some challenges for the puncture. During the operation, the left femoral artery should be selected as the main approach, and ultrasound guided puncture should be used; There are transverse heart and acute angle arch, and the calcification of the valve is heavy, so we can consider to preset snore to assist valve delivery; The height of bilateral coronary arteries is acceptable, and the length of bilateral valve lobes is less than the distance from the valve root to the coronary artery orifice, and the space of the sinus is acceptable. It can be seen that this patient has a low risk of coronary artery orifice occlusion.

——Celebrities' comments——

Professor Fang Zhenfei: The ultrasonic evaluation of this case shows that there are channels on the "tumor", which is definitely a sinus tumor rather than a membranous tumor. This is a basic concept. Because the membranous tumor is located in the lower structure, it will not erode upward, while the sinus tumor can cause erosion. The sinus tumor itself is usually poorly developed, and may appear prolapse. The location is relatively low, or even lower than the level of the valve ring. As long as there is a channel above the heel, it must be the sinus tumor channel. From the current strategy, it is not considered to block the sinus tumor before TAVR, but to directly use the valve skirt to block the reflux. In this case, it is more advantageous to choose ball expansion valve. Because this type of valve frame is short, even if the subsequent closure is not successful, it is relatively easier to treat again.

Professor Feng Yuan: The aneurysm of the ventricular septum is in a relatively limited scope, with 1/3 above the crisscross and 2/3 below the crisscross. The aneurysm of the membranous part only exists between the right side and does not extend below the pulmonary artery. At present, the reflux is located between the pulmonary artery and the aorta, in the direction of the bypass. Therefore, it must be a sinus aneurysm, and I think it may be a sinus aneurysm caused by infection, facing the pulmonary artery, Even if rupture occurs, it is unlikely to cause fatal effects.

Professor Song Guangyuan: It can be considered to block the sinus tumor first, and then conduct TAVR, which can significantly reduce the difficulty of TAVR. And from the perspective of patient prognosis, on the basis of blocking the sinus tumor above, blocking the lower side may be more helpful to improve the long-term prognosis. If the blood flow in the lower cavity is continuously impacted, the cavity may gradually expand. Therefore, a two pronged approach may help to avoid this situation. However, if you choose to block first, it is not recommended to choose ball expansion. Because the metal occluder has been implanted, and then the powerful balloon is used to expand, the metal may burst the weak sinus tumor. In addition, the self expanding valve should be selected. It is better to select a moderate oversize rather than an oversize.

Northwest Division Team - Image Analysis and Strategy Development of "Severe AS and Mild AR"

Doctor Cong Guangzhi

Doctor Zhu Cunjun

Doctor Ma Wenshuai

The patient was a 71 year old male with severe AS and mild AR diagnosed by ultrasound. It is planned to perform the TAVR operation under the guidance of general anesthesia and TEE. Combined with CT evaluation, the patient has extremely severe calcification (T-type calcification). The calcification score is 3569 mm3, and there is a risk of valve ring rupture. It is recommended that surgeons prepare a table; It is a type 1 bicuspid valve with a 28.8 mm annulus, calcification extending to the outflow tract, and the risk of perivalvular leakage is high. It is recommended to prepare a set of perivalvular leakage blocking device; The presence of extremely severe calcification indicates that the patient is at risk of cerebral infarction, and it is recommended to place the brain protection device in advance. In addition, the patient has ascending dilation and calcification on the right side. It is recommended to prepare snare cross valve to avoid cross valve difficulties; The calcification in the restricted area above the valve is too heavy, and there is a risk of valve frame moving down and folding. The appropriate valve model should be selected according to the ball expansion, and it should be expanded back if necessary; Due to the existence of certain coronary risks, coronary protection should be prepared during the operation according to the balloon dilation (especially the calcified mass in the right coronary lobe); Due to the existence of extremely severe calcification, the risk of balloon dilatation valve implantation is too high, so the self expanding valve with sufficient radial support should be selected; The internal diameter of the inferior vena cava is 1.7 cm, indicating insufficient blood volume. Attention should be paid to preoperative+intraoperative fluid replacement. In order to prevent circulatory collapse, valves should be pre installed in advance; Ultrasound showed that the aorta was lowered by 1.7 cm, and it was suspected that the aortic arch was narrowed. During the operation, a catheter should be used to measure the pressure difference; It is planned to use the right femoral artery as the main approach. It is recommended to initially position the valve ring at position 0 to the valve working position, and closely observe the valve shape and left and right coronary perfusion.

——Celebrities' comments——

Professor Feng Yuan: This patient meets the TAVR indication. In the past, when conducting TAVR surgery, the expert group considered patients with moderate or low-risk surgical risks carefully. However, with the improvement of evidence-based, at present, the consensus of Chinese TAVR experts has included patients over 70 years of age and at low risk of surgery into the relative indications; Patients over 70 years of age with moderate surgical risk also have the indication of TAVR.

Professor Liu Xianbao: The key is to develop a good TAVR surgical strategy. As long as the strategy is appropriate, the valve type and size are selected properly, and the implantation process is standardized, good surgical results can usually be achieved. For this patient, there is no doubt that the choice of valve type should be self expanding valve. For patients with such severe calcification, it is wise to choose a self expanding valve with strong support. As for the implantation depth, considering that the calcification is heavy and the valve is a bicuspid valve, it can be slightly elevated at first. If there is a slide, it is not recommended to completely recover the Qiming valve, but it can be slightly withdrawn. After partial recovery, it can be released again. If the valve position is still deep, it still needs to be partially recovered. This time, it can be recovered a little more. Finally, the valve can be in an ideal position after release.

ROUND 2, 3 -- [Individual Battle] Select carefully and fight back

"Petal" shadow accompanying 2023 picture reading contest

After an intense and highly educational case sharing session, the second and third sections of the competition were carefully selected and the Jedi counterattacked. These two links were conducted in the form of answers, covering image analysis, complications and potential risk prediction, guidelines consensus, severe aortic regurgitation standards and other types of content. Not only did you consider the ability to read pictures, and your knowledge of the field of TAVR, but also it was the key link for the six players to turn the table against the wind and decide the final place to enter the finals!

In the face of the diversified and complicated problems in the field of TAVR, all the contestants showed great enthusiasm and courage. After your singing, we came on the stage, and we gave each other our strength. We competed not only for speed, but also for the mastery of professional knowledge. Every time a contestant answers a question correctly, the applause is thunderous, which is recognition of their excellent professional level. Even if there is a wrong answer, the judges and guests will generously share their experience, guide them to solve problems, hit the core of the problem, and lead them to think and judge together. Through this process, we can learn from each other's mistakes and work together to improve our comprehensive ability. This is not only a contest of knowledge, but also an opportunity to learn and grow together.

Award ceremony - three players successfully won tickets to the finals!

"Petal" shadow accompanying 2023 picture reading contest

The field of structural heart disease intervention is the frontier field of medicine today. With the continuous innovation and progress of technology, more and more excellent operators have demonstrated their outstanding level and style in this field. On the competitive stage of the second round of the semi-final of the AP-SHD "valve" image accompanying reading contest, after three rounds of exciting and fierce competition, six contestants fully demonstrated the extraordinary spirit of our heart valve doctors! The exciting and intense competition came to an end in the discussion of experts. After summarizing the scores of experts, the final ranking of the competition was announced in the hot academic competitive atmosphere! The top three players who won the score this time were: champion doctor Cong Guangzhi, runner up doctor Ma Wenshuai, and runner up doctor Chen Yang.

summary

"Petal" shadow accompanying 2023 picture reading contest

The wonderful and diverse display and in-depth analysis of image analysis results, and the sharp questions and experience sharing of experts time and again, not only demonstrated the ideas and thinking of different operators, but also provided opportunities for doctors to learn from each other. The AP-SHD "petal" image accompanying reading contest is not only a contest of skills and wisdom, but also a stage for mutual learning and common progress. At the end of the competition, Professor Song Guangyuan concluded that imaging evaluation is an important basis for TAVR surgery, and the holding of the AP-SHD "flap" image accompanying reading contest is of great significance for cultivating the image reading ability of operators. Relying on this highly innovative academic competition platform, Chinese young and middle-aged outstanding artists can fully demonstrate their own level of involvement in the exchange and mutual learning, clearly understand their own technical weaknesses under the guidance of several domestic academic masters, and then achieve all-round growth in learning from each other's strengths and learning from others' strengths; Professor Feng Yuan further said that "the soldiers and horses are not moving, and food and grass go first". For TAVR practitioners, "food and grass" is image analysis. This "petal" image accompanying reading contest has obviously made remarkable progress compared with the past. Both the players and the experts who participated in the contest can learn from it, which shows that the contest is very successful. Looking forward to the future, on the road of vigorous development in the field of heart valve intervention, we look forward to the continuous progress of clinicians, and also look forward to the better and better competition, and jointly promote the development and progress of this field!

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