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Objective To analyze and summarize the treatment strategies for unstable angina with no-reflow phenomenon after PTCA during early percutaneous interventional procedures.Methods A total of 32 cases with unstable angina were divided into two groups:one group with drug therapy and the other group with drug therapy and thrombus aspiration catheter.The patients were chosen when there was no-reflow phenomenon after PTCA during early percutaneous interventional procedures and their clinical data were compared and analyzed.Blood flow TIMI grade,myocardial perfusion grade (MBG),TIMI myocardial perfusion (TMP) grade and other indexes were observed and recorded.Results The general conditions had no statistical difference between two groups.Compared with the drug therapy group,the proportion of patients with TIMI,MBG and TMP grade 3 was higher in aspiration and drug therapy group (89％ VS 71％ P＜0.05).Conclusion Drug therapy and thrombus aspiration catheter in treatment helps to improve myocardial perfusion level for unstable angina with no no-reflow phenomenon after PTCA during early percutaneous interventional procedures.
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Objective To observe the clinical efficacy of bosentan in treatment of severe pulmonary hypertension related to congenital heart disease (CHD-PAH) .Methods 5 patients with severe CHD-PAH patients received bosentan therapy, then pulmonary artery pressure, pulmonary vascular resistance (PVR), 6min walk test,right ventricular end-systolic diameter (RVSD) changes were observed and statistically analyzed after six months medication. Results Pulmonary arterial systolic pressure (sPAP) was significanfly decreased from (96±11) mmHg to (86±10) mmHg, <0.01.pulmonary arterial diastolic pressure (dPAP) was significanfly decreased from (56±10) mmHg to (46±9) mmHg ( <0.01),pulmonary arterial mean pressure (mPAP) was significanfly decreased from (73 ±11) mmHg to (59 ±10) mmHg ( <0.05), pulmonary vascular resistance was significanfly decreased from (17.8±1.9) Wood to (13.1±1.7) Wood (<0.01) . 6min walk test was improved from (136±40) m to (198±55) m, <0.01.right ventricular end-systolic diameter significanfly decreased from (40±5) mm to (36±6) mm after 6 months therapy ( <0.05) . Conclusion Bosentan can decrease pulmonary arterial systolic pressure, improve exercise tolerance, improve right ventricular function in patients with severe CHD-PAH.
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Objective To study the ralationship of arrhythmias and heart electrical parameters changes after transcatheter closure of ventricular septal defect (VSD) .Method 50 patients had been successfully finnished the transcatheter closure of ventricular septal defect,and then we observed ralationship of arrhythmias and heart electrical parameters changes. Results (1) Compared with the situation of VSD occluder preoperative and postoperative, during follow-up there were 20 arrhythmia cases, including bundle branch block 16 cases, including the complete left bundle branch block 2 cases,complete right bundle branch block 4 cases,a transient third-degree trioventricular conduction block 1 case, most return to normal in the follow-up. 2 Intracavitary electrogram showed before and after transcatheter closure:A-V conduction parameters A-H,H-V value of (75.10 ± 14.34) ms vs (80.67±23.03) ms and (47.9±12.61) ms vs (50.07±15.23) ms,the difference was not statistically significant ( >0.05) . Conclusions (1) Some patients with new ECG changes after transcatheter closure of VSD, manifested as an increase in bundle branch block in a week, but most return to normal,the prognosis is good. (2) Intraoperative A-H,H-V extension is not related with with postoperative slow arrhythmia;(3) Arrhythmia is a common complication after VSD transcatheler closure, to strictly selecte indications,and to avoid too large diameter are the effective measures to reduce the arrhythmias after transcatheter closure of ventricular septal defect (VSD) .
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Objective To discusse the mechanism and clinical significance of bradycardia -hypotension phenomenon which is caused by vagal reflex during and after the RFCA and present the experience of using appropriate measures to decrease the incidence of this situation. Methods The patients who were suffering from tachyarrhythmias and treated by RFCA were divided into two groups. The groups were as follows:148 patients who were not taken special measures in the early stage were selected in control group;1 540 patients who were taken measures to prevent vasovagal reflex were selected in observation group. Result During the RFCA, the incidence of bradycardia -hypotension phenomenon in control group was 13.5% (20/148), the incidence of bradycardia-hypotension phenomenon in observation group was 5.0%(77/1540) (<0.01) .Conclusions The incidence of bradycardia-hypotension phenomenon caused by vagal reflex during the RFCA is related to catheter irritation to the heart,pressure on the vessels and hypovolemia. The incidence of this phenomenon can be decreased obviously by some measures,such as non-restricted diet before RFCA,discretion rehydration during and after the RFCA and hemostasis with appropriate force after extubation. The key to rescue patients successfully are early detection and timely processing.
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Objective To evaluate the feasibility of catheter ablation of Para-Hisian Atrial Tachycardia guide by CARTO. Method Catheter ablation guided by CARTO was performed after activation map in three patients with Para-Hisian Atrial Tachycardia. Result Successful ablation was got at right atrial in two patients and at non-coronary in one patient. Conclusion Catheter ablation guided by CARTO is safe and efficient for Para-Hisian Atrial Tachycardia.
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Objective To study the effect of implanted stent or selected operation in patients with acute occlusion of right coronary artery during the emergency coronary arteriongraphy. Methods Forty-three patients with acute occlusion of right coronary artery who underwent the emergency coronary arteriongraphy were divided into two groups: the implanted stent group ( n = 23) during the emergency coronary arteriongraphy and the selected operation group (n =20) during the emergency coronary arteriongraphy . Then we observed the general data, the coronary artery pathological changes, preoperative and postoperative thrombus, the blood flow, remained stenosis and the prognosis. Results The implanted stent group was similar to the control group in general condition, but implanted stent group was significantly different from the control group in the near, intermediate and distal coronary artery pathological changes ( <0.05) . The control group was significantly different from the implanted stent group in the thrombus and slowly blood flow ( <0.05) . After three months, we reviewed coronary arteriongraphy and selected operation, The implanted stent group was significantly different from the control in the remained stenosis and slowly blood flow (<0.05) . But the implanted stent group was similar to the control groug in the thrombus and new proceeding cardiovascular events. Conclusion When thrombus appears in acute occlusion of right coronary artery, we can implant stent during the emergency coronary arteriongraphy if the thrombus is little, or we can select operation after PTCA on the contrary.
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Objective To evaluate the feasibility and effect of three-points ablation approach in in treatment of typical atrial flutter guided by CARTO. Methods Twenty-six patients with typical atrial flutter diagnosed by ECG and electrophysiological study (EPS) were enrolled in this study. Activation sequence mapping and linear ablation were performed in 11 patients (conventional group) . Three-points guided linear ablation with CARTO system was performed in another15 patients (three-points group) . Results There was no significant difference in the success rate between the two groups. Both the procedure and fluoroscopic time in three-points group were significantly shorter than that in conventional group [(72.66±29.82) vs (102.52±32.61) min;(4.26±2.76) vs (7.32±3.16) min] . Conclusions The three-points ablations approach is as safe and effective as conventional ablation approach in treatment of typical atrial flutter;however,the former can significantly shorten the procedure time and fluoroscopy time.
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Objective This study was purposed to analyze and summarize the vein temporary cardiac pacing therapy in patients with acute inferior wall myocardial infarction complicated by high degree atrioventricular block (AVB) . Methods One hundred and twelve patients with acute inferior wall myocardial infarction complicated by high degree AVB were selected as observation and research subjects, and they were treated by vein temporary cardiac pacing therapy. The safety, availability of different kinds of this surgical methods and the relationship between these surgical methods and complication were observed. Results Three out of 60 patients who were treated by ordinary temporary pacing electrode catheter were suffering from cardiac tamponade. No serious complications occurred when 52 patients were treated by floating temporary pacing electrode catheter. Conclusion Floating temporary pacing electrode catheter have already proved safe and effective in the treatment of acute inferior wall myocardial infarction complicated by AVB, and it could decrease the incidence of serious complications such as myocardial perforation.
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Objective To test synchronization of cardiac mechanical contraction by means of advanced echocardiography and investigate the correlation of left ventricular ejection fraction (LVEF) and the indexes of mechanical dyssynchrony, and the relationship between DTI, STI and RT-3DE.Methods Control group (20 cases), chronic heart failure with a widened QRS complex (12 cases) and chronic heart failure with a shortened QRS duration (10 cases) were selected. We evaluated mechanical dyssynchrony with the DTI, the STI and the RT-3DE, and analyzed the correlation between the improvement degree of cardiac function and indexes of mechanical dyssynchrony, and the correlation between DTI, STI and RT-3DE. Results (1) In CHF groups (including shortened QRS group and widened QRS group), the indexes of synchronization of cardiac mechanical contraction were higher than control group ( 0.05) . (3) In CHF groups (including shortened QRS group and widened QRS group), the indexes of mechanical dyssynchrony before operation were higher more than after operation ( 0.05) . (5) There was a significant negative correlation between the LVEF and the indexes of mechanical dyssynchrony (<0.01) . (6) .In the indexes of synchronization of cardiac mechanical contractions, there are significant positive correlations between the DTI, the STI and the RT-3DE ( <0.01) . Conclusion Echocardiography can be used to screen CHF patients,and patients with left ventricular synchronous (including shortened QRS duration) can also be benefited from CRT.
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@#Objective To investigate left ventricular systolic function with mitral annulus motion velocity(Sa) with pulsed-wave Doppler tissue imaging(PW-DTI) in patients with coronary arteriosclerosis disease(CAD) after percutaneous coronary intervention(PCI).Methods 52 patients with CAD,who were determined by coronary artery angiography,were divided into two groups,PCI group(n=33) and non-PCI group(n=19).They were followed up with PW-DTI and conventional echocardiography before and 5 d,3 months and 6 months after intervention in PCI ones,before and 6 months after angiography in non-PCI ones.In PCI group,the patients were divided two subgroups: EF≥50% and EF=30%～50%.Results The Sa improved significantly in PCI group 6 months after intervention(P<0.001).EF correlated with Sa(r=0.705,r=0.770 pre-and post-intervention respectively,P<0.0001).Conclusion Sa can be used to evaluate left ventricular systolic function of CAD patients.
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Objective To assess myocardial contractility in essential hypertention(EH) of different remoldings by means of circumferential midwall fractional shortening (mFs), relation between mFs and circumferential end-systolic stress(mFs-cEss). Methods The eject fraction(EF), circumferential end-systolic stress(cEss), fractional shortening(Fs), mFs was calculated in 115 EH patients and 29 normal controls. Relations in mFs-cEss, Fs-cEss between the subjects were analysed with linear correlation and linear regression. Results In using EF,Fs,Fs-cEss to assess chamber function of the patients with hypertension of four left ventricular remoldings, it shows apart from eccentric hypertrophy, the rest three remoldings were overestimative. MFs assessing myocardial contractility in four remoldings was lower than that of the controls, especially obvious in concentric hypertrophy patients(P
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Objective an experimental animal model of acute myoc ardial infarction (ANI) was established by opening chest and ligation of the left anterior descending (LAD) coronary artery． Methods a total of 20 rabbits were opened chest and ligated LAD under sterilization． Electrocardiogram (ECG) and myocardial-enzymes in blood serum were investigated． Results ECG of all rabbi t s showed normal before operation． Irmediately after and 1/2 hour after ligation , ST-segment elevated and ECG showed ambulatory changes for 7 and 9 rabbits respectively． Two hours after LAD ligation, the change of ECG for 2 rabbits wa s not typical and 2 of them died during experiment． Four weeks after operation, E CG of 18 rabbits showed the chest leads had pathologic Q waves． Twenty-four ho urs after LAD ligation, AST, LDH, LDH-1, CK and CK-MB in blood serum were significantly increased． There was significant difference compared with before operation (except LDH) (P<0. 0l)． Conclusions:The method was sim ple and well repeated． The formation of myocardial infarction was reliable and rabbits were maintained for a long time after operation． It provides a valuable animal mode l for the experiment study of coronary heart disease．
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Objective To study the effects of basic fibroblast growth factor gene in enhancing collateral vessel formation of coronary artery in the ischemic myocardium of swine.Methods All swines were distributed into the operation control group(n=6) and treatment group.The treatment group was further divided into 2 groups according to the route of injection either through the right coronary artery or the left coronary(n=6 respectively).The animal models of AMI were prepared by ligating the left circumflex(LCX) coronary artery.Two weeks after the operation,2?000 ?g of pcDNA_3-bFGF eukaryotic expression plasmid was directly injected into the coronary artery by catheter.Two weeks after the gene injection,evaluation of collateral circulation formation was made by means of coronary angiography and immuohistological staining ect.Results (1) Through immuotistological staining,the vessels count in both treatment groups was more than that in the control group;(2) Selective coronary angiography at 4 weeks after the operation showed that the number of newly formed collateral vessels in the bFGF gene treatment group was more than that in the control group.On the other hand,more collateral vessels were found in the group through left coronary injection compared with the group through right coronary injection.Conclusion Intra-coronary artery injection of bFGF gene can improve collateral vascular formation in the ischemic myocardium of swine.
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Objective To establish an experimental animal model of acute myocardial infarction (AMI) in the swine. Methods Under sterilization, the swine’s chest was cut open and the left circumflex coronary artery (LCX) was ligated.Results After the operation, the changes of Electrocardiogram (ECG) and myocardial-enzymes in the blood serum and selective coronary angiography all proved that the animal model of AMI in the swine was successful. Conclusions Ligating coronary was a valuable method to make an animal model of AMI.