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Objective To compare the safety and efficacy of direct and remedial rotational atherectomy in the treatment of heavily calcified coronary artery lesions.Methods We retrospectively reviewed 58 patients admitted in the Shanghai Chest Hospital and Liaocheng People Hospital from May 2012 to July 2015 who had received stent implantation and rotational atherectomy.The 58 patients were divided into two groups which were the direct atherectomy group (n =27) and the remedial atherectomy group (n =31).General clinical date,lesion and procedural characteristics,intraoperative complications,in-hospital and follow-up MACCE were compared between the two groups.Results There were no differences between the two groups in general clinical date intraoperative complications,amount of contrast agent used,proceduraltime,rates of in-hospital and follow-up MACCE.Nevertheless,compared with the direct artherectomy group,the remedial group had more number of balloon dilations during procedure [3 (1,5) vs.2 (1,2),P ＜ 0.001] and higher peak cardiac troponin levels [1.1 (0.3,3.0) μg/L vs.0.5 (0.1,2.3) μg/L,P =0.032].Conclusions Remedial rotational atherectomy with drug-eluting stent had the same safety and efficacy as direct atheretomy with drug-eluting stent in treating patients with heavily calcified coronary lesions.It is reasonable and safe to transform routine PCI to remedial rotational atherectomy when the 2.0 mm semi compliant balloon or/and 2.5 mm non-compliant balloon cannot pass through or dilate the lesions.
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Objective To evaluate the utility of multi-slice computed tomography (MSCT) in assessing acute non-reperfused myocardial infarct size. Methods Seven domestic pigs (mean weight 17.3 ± 1.9 kg) underwent ligation of the distal left anterior descending artery to establish a model of acute myocardial infarction (MI). MSCT and triphenyltetrazolium chloride (TTC) staining were performed two hours later. The following data were acquired and analyzed:MI volume (%), CT values of the infarcted region, left ventricular cavity and normal cardiac tissue at various scanning time-points (1, 5, 10, 15, 20 min after contrast injection). Results Using MSCT, the overall MI volume showed a time-dependent decrease, with a reduction of 28.87%after 20 min. The greatest reduction occurred at the 5 min time-point. In TTC staining, MI volume was 9.87%± 2.44%. When MI size, as determined by MSCT, was compared with that by TTC staining in Bland-Altman plots, there was a better agreement at 5, 10, and 15 min time-points at 1 and 20 min. Conclusions The study indicates that double-phase scanning examination using MSCT is a useful tool to assess MI size, and the optimal late-phase scanning time-point set within 5-15 min of contrast injection.
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Background Evaluation of acute myocardial infarction after reperfusion by dual phase contrast-enhancement multislice computed tomography (MSCT) was implicated in porcine model. There have been few attempts to use this diagnostic modality for the early assessment of coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI), especially after primary percutaneous coronary intervention (PCI). In elderly patients with STEMI, the safety issues remain unknown. Methods Dual phase contrast-enhancement MSCT examinations were performed in 11 elderly patients (≥60 years old) with STEMI within one week after primary PCI. The presence, location and enhancement pattern on MSCT were evaluated. MSCT findings were compared with the catheter angiographic results and area under the curve of creatine kinase (CK) release. Serum creatinine level was recorded before and after MSCT scan. Results MSCT scans were successfully performed in all the patients. Early myocardial perfusion defect (early defect, ED) was detected in all of the 11 patients (100%) in the early phase of the contrast bolus (subendocardial ED in 10 patients and transmural in 1 patient). Mean CT attenuation value of ED was significantly different from CT attenuation value of remote myocardium (46±17 HU vs 104 ± 17 HU; P < 0.01). Location of ED area correlated well with infarction related artery territory on catheter angiography in all of the 11 patients (100%). On delayed phase of MSCT scan, different enhancement patterns were observed: isolated subendocardial late enhancement (LE) in 6 patients, subendocardial residual perfusion defect (RD) and subepicardial LE in 1 patient, subendocardial RD in 4 patients. Infarct volume assessed by MSCT correlated well with area under the curve CK release (R=0.72, P < 0.01). Serum creatinine level after MSCT scan showed no difference with that before MSCT scan. Conclusion Dual phase MSCT could be safely implicated in elderly patients with STEMI. Variable abnormal myocardial enhancement patterns were seen on dual phase MSCT in these patients with STEMI after primary PCI. Assessment of myocardial attenuation on MSCT gives additional information of the location and extent of infarction after reperfusion.
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Objective To compare the safety and recent efficacy between transcatheter and surgical closure of secondum atrial septal defect over 50 years of age. Methods Retrospective analysis was done on 66 patients over 50 years of age who underwent transcatheter (30 cases) and surgical (36 cases) closure of secondum atrial septal defect.The median age was 60.8?7.1 years old in the transcatheter closure group and (57.5?6.3) years old in the surgical closure group( P=0.04).The median sizes of atrial septal defect in the transcatheter and the surgical closure group were 24.9?7.2 mm and 30.4?11.0 mm respectively (P=0.02). We compared the recent efficacy、 complications and prognosis between two groups. Results The instant procedural success rate was 93.3% for the transcatheter closure group and 100% for the surgical group (P=0.85). 2 procedures in the transcatheter closure group failed, 1 patient (2.6%) in the surgical group died during hospitalization and 9 patients (25.0%) underwent Devage tricuspid annuloplasty. Newly onset atrial arrhythmias occurred in 3.3% in the transcatheter closure group and 22.2% in the surgical closure group (P=0.03). After the procedures, right atrial and ventricular dimensions were decreased from 38.0?9.0 mm to 35.2?10.1 mm and from 44.2?8.6 mm to 36.2?9.0 mm in the transcatheter closure group whereas in the surgial group, the atrial and ventricular sizes fell from 44.1?8.2 mm to 38.2?9.5 mm and 49.0?10.2 mm to 37.1?11.0 mm respectively (P
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Objective To elucidate the efficacy and safety of transcatheter closure of secondary atrial septal defect (ASD) with Amplatzer septal occluder (ASO) in people over 50 years of age. Methods Retrospective comparison of 41 patients (14 males, 27 females) with ASD over 50 years of age ranging from 50 to 75(mean age 55.5?7.6, elder group) was conducted with 132 patients younger than 50 years(control group). After diagnosis of ASDs and evaluation of pulmonary artery systolic pressure and right atrial and ventricular dimensions by transthoracic echocardiography (TTE), all patients underwent transesophageal echocardiography (TEE) for complete assessment of ASD size, margins and anatomic relationship of the defect before closure of ASD. Each case was treated with ASO through the percutaneous transcatheter procedure under fluoroscopy and TTE or TEE. Early follow up(3 months) by echo was taken after the intervention. Results There was no difference of mean defect diameter measured by TEE and the balloon-stretched defect diameter of the ASDs between 2 groups. Pulmonary artery pressures in elder group were higher than those in younger group(P