Objective To evaluate the effect of post -dilatation with highpressure for reducing subacute thrombosis after intracoronary drug-eluting stent(DES) implantation. Methods The cohort of consecutive coronary heart disease patients with implanted DES from January 2004 to June 2009 were studied. The 838 patients were divided into 2 groups depending on whether they were post-dilatated with high-pressure. There were 501 patients in non-post-dilatation group,male 353,female 148,aged 40 -82 years,mean age 61.4 years,and 337 patients in post-dilatation group,male 235,female 102,aged 37 -86 years,mean age 62.9 years. The clinical features,pathological changes of coronary artery,profiles of DES implantation and subacute thrombosis were recorded. Besides,the effects of post-dilatation for reducing subacute thrombosis of 2 groups were observed and analyzed. Results There were no statistical differences in the aspects of clinical features,pathological changes of coronary artery and profile of DES implantation between 2 stages. The rates of subacute thrombosis in 2 stages were 0 % and 1.62 % respectively,which were significantly decreased,there was statistical difference between 2 stages(P 0.05). Conclusion The post-dilatation with high-pressure after DES deployment could reduce the rate of subacute thrombosis.

Objective To evaluate the impact of optical coherence tomography(OCT) for high pressure post-dilatation after coronary artery stent implantation.Methods A cohort of 29 consecutive coronary heart disease patients with an average age of(59.2±4.5) years(40-77 years) old who had finished percutaneous coronary intervention from July 2007 to July 2009 were retrospectively analyzed.Coronary angiography and stent implantation were done according to standard methods,and OCT examination was done after stents expanded with named pressure and high pressure balloon post-dilatation respectively,as well as the stent struts apposition,intimal prolapse and micro-dissection were analyzed.Results Twenty-nine patients finished OCT examination successfully without angina and heart failure complications in the surrounding operation stage.The distance between the vessel wall and stent struts of high pressure balloon post-dilatation(94.00±22.42) μm was significantly shorter than that of the stent named expansion(137.38±26.80) μm,with statistically significant difference(P0.01).The incidence of intimal prolapse and micro-dissection with high-pressure balloon post-dilatation(respectively 14 and 0) were significantly less than that of stent named expansion(respectively 32 and 5),and both of them had statistic difference(P0.05).Conclusion There is a certain guide role of OCT for high pressure balloon post-dilatation after stent implantation.

Objective To evaluate the effect of different speed of fluid infusion on platelet aggregation in patients with coronary heart disease during the perioperative period of stent implantation.Methods A cohort of consecutive coronary heart disease patients with coronary angiography and corresponding treatment from Jan,2009 to Jun,2009 was selected at random.Thirty seven patients were included in the study and they were divided into 2 group according to the speed of fluid infusion they received.The 2 groups included the control (n=17,infusion rate at 1.5-2.0 ml·kg-1·h-1) and the quick infusion group (n=20,infusion rate at 6-9 ml·kg-1·h-1).Changes in clinical manifestation,blood pressure,ventricular heart rate,platelet aggregation and osmotic pressure of plasma were recorded during the perioperative period.Results Five patients from the quick infusion group had minor bleeding complication without severe adverse event,and 4 patients from the control group had minor bleeding complication.Three patients from the control group were removed from the study because of new onset of chest distress,chest pain and low blood pressure status.The changes in ventricular heart rate,blood pressure and plasma osmotic pressure had little relationship with the speed of fluid infusion (P0.05).The rate of platelet aggregation was not obviously changed during the perioperative period in the control group (P0.05),but the rates of platelet aggregation were lower at 4 hours after the operation when compared with the preoperative level in the quick infusion group (P0.05).Conclusion It was safe to give quick fluid infusion to coronary heart disease patients during perioperative period.Moreover,quick fluid infusion could further lower the rate of platelet aggregation.

1 临床资料 患者女性,69岁,活动后胸闷胸痛3年,加重3d,于2005年饱餐后快步行走或上2层楼出现胸闷胸痛,持续10min左右,休息或含服硝酸甘油缓解.3d前上述症状加重,轻微活动就能诱发,伴有恶心和出汗,硝酸甘油不能缓解,经急诊处理后入院.无高血压病、糖尿病史,无吸烟饮酒史.

A 69-year old female patient was admitted because of 3 days of worsened chest pain. Coronary angiography showed 60% stenosis of distal left main stem, chronic total occlusion of left anterior descending (LAD), 70% stenosis at the ostium of a small left circumflex, 70-90% stenosis at the paroxysmal and middle part of a dominant right coronary artery (RCA), and a normal left internal mammary artery (LIMA) with normal origination and orientation. Percutaneous intervention was attempted but failed on the occluded lesion of LAD. The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davinci robot. Eleven days later, the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously. Then the patient was discharged uneventfully after 3 days hospitalization. Our experience suggests that two stop shops of hybrid technique be feasible and safe in the treatment of elderly patient with multiple coronary diseases. (J Geriatr Cardiol 2008; 5:186-189)

评价血管内光学相干断层成像(optical coherence tomography,OCT)在冠状动脉临界病变诊治中的作用. 对象与方法 1.对象:10例冠心病患者,其中不稳定型心绞痛8例,稳定型心绞痛2例;男6例,女4例,年龄61.2±11.1岁;冠状动脉造影证实均为狭窄程度50%～70%的临界病变,共12处.

Objective To evaluate the acute vascular events in the segment of coronary artery proximal to the target lesion during interventional procedure in elderly. Methods Nine hundred eighty-six old patients who received elective coronary intervention from 2001 to 2004 were evaluated retrospectively. The incidence, character and treatment of acute vascular events due to the injury of a lesion proximal to the target lesion located at middle or distal segment of the target coronary artery were analyzed. The image characters between proximal lesions complicated with and without acute vascular events were compared. Results A total of 2 136 target vessels and 2 367 target lesions were treated with interventional therapy and altogether 2 556 stents were implanted. The success rates of lesions and casees were 100% and 99.9% respectively. Complication and mortality rates were 0.5% and 0.1%. There were 261 lesions (12.2%) located proximal to the target lesions in 2 136 target coronary arteries. Acute vascular events occurred in twenty-four of them (9.2%), including dissection 11 (45.8%), acute thrombosis 5 (20.8%) and serious vascular spasm 8 (33.3%). There was no significant difference between proximal lesions complicated with and without acute vascular events in image characters (P0.05). The acute vascular events were treated with emergency stenting in 11 cases (45.8%), stenting after intracoronary artery thrombolysis in 4 cases (16.7%), stenting after intravenous thrombolysis in 1 case (4.2%) and repeated intra-coronary injection of nitroglycerin in 8 cases (33.3%). Conclusion (1) The accurate identification of the lesions located proximal to the target lesions is mandatory for the decision making and strategy of coronary interventional therapy in elderly. (2) Procedure-related injury to the proximal lesions is one of the important causes of acute vascular events. (3) Protecting and stabilizing the proximal lesions are important measures to decrease peri-operative complications. (4) Aggressive postoperative medical therapy for stabilizing any possible injured proximal lesion is strongly suggested in elderly.

Objectives: To report the clinical experience of combined interventional procedures in the treatment of elderly patients with coexisting two or more cardiovascular diseases in our medical center, and to assess the feasibility, safety and therapeutic efficacy of this management strategy. Methods: Patients were selected to the study if: 1) age ＞65 years; 2) with coexistence of two or more cardiovascular diseases which are indications for interventional therapy; 3) patients’ general condition and organ functions allow the performance of combined multiple procedures; 4) the predicted procedure time is within 150 min; 5) the predicted contrast medium dosage is within 300 ml. The criteria we analyzed included procedural type, procedural time, fluoroscopy time, dosage of contrast medium, success rates of the procedures, complications and in-hospital mortality. All patients were followed up for 30.4±9.3 months, to determine the all-cause mortality, recurrence rates and adverse cardiac events. Results: From January 2000 to December 2004, combined interventional procedures were performed on 136 patients, with 2 procedures on 134 patients and 3 procedures on 2 patients. The mean procedure time was 115.4±11.6 min, the mean fluoroscopy time was 35.7±9.3 min, and the mean dosage of contrast medium used was 183.6±19.4 ml. Procedural success rate was 100%, no procedure related death or major complications occurred. Conclusion: Performed by a competent team, combined interventional procedures in elderly patients with multiple cardiovascular diseases were feasible and relatively safe.

Objective To compare the efficacy of temperature-controlled (TC) and impedance-limited (IL) ablation in the treatment of type-Ⅰ atrial flutter (AF) in the elderly. Methods During AF or coronary sinus ostium pacing, TC or IL ablation was randomly used to isolate the posterior isthmus between the the tricuspid ring and inferior vena cava. The target temperature of TC group was 70°C with automatic energy modulation. The impedance upper margin of IL group was 150  with pre-set 20 W energy. Procedure endpoint was complete block of posterior isthmus. Seven parameters were compared between two groups. Results Thirty-seven AF patients were randomized into TC (19 cases) and IL groups (18 cases). There were no differences between two groups in gender, age, basic heart disease, AF rate and reentrant type (P0.05). All patients were treated successfully without complications. Seven parameters were compared between TC group vs IL group: (1)energy delivery frequency 6.4±3.5 vs 11.3±5.8(P0.05), (2)energy delivery time 572.8±96.5 vs 914.7±97.6 sec(P0.05),(3)procedure time 45.2±11.4 vs 56.6±18.3 min (P0.05),(4)fluoroscopy time 13.5±6.3 vs 21.4±7.6 sec(P0.05),(5)energy for ablation 14.3±6.5W vs 19.1±3.2W (P0.05),(6)high impedance alarm frequency 0 vs 5.8±3.6(P0.05), (7)chest pain rate 10.5% vs 55.6%(P0.05).Conclusion In the electric isolation of posterior isthmus of aging AF patient, TC ablation is superior to IL ablation in following aspects: (1)less energy delivery number, shorter time and lower energy, (2)shorter fluoroscopy and procedure time, (3)less high impedance alarm frequency, and (4)better patient's tolerance.

目的:探讨在肺静脉造影和标测电位指导下,以超声球囊导管消融肺静脉口治疗局灶性房颤的近远期疗效.方法:采用肺静脉超声消融.结果: 9 例患者共确定 24 条靶肺静脉,即左、右上肺静脉各 9 条,左下肺静脉 6 条.消融(4.3±1.5)次,实际温度(57.2±3.6)℃,每次消融时间(96.8±12.5)s,每例平均消融(378.6±41.3)s,肺静脉电位振幅降低80%以上.消融中9例患者均有胸痛,7例需静脉注射吗啡缓解,无并发症.房颤于术后(48.3±11.7)h复发,均开始服用抗心律失常药物.随访(11.8±7.5)月,房颤发作从术前每周(5.7±3.9)次减少到(3.4±2.3)次.结论:①以房早消失、肺静脉电位振幅降低和实际消融温度不能作为即刻疗效终点,②晚期肺静脉口重构效应能减少局灶性房颤的远期发作,③超声球囊导管消融靶肺静脉后房颤的近期复发不能代表远期疗效.

Objective To evaluate the influence of a new digital angiographer INNOVA 2000 on the effect and safety of percutaneous coronary revascularization in the elderly. Methods Patients were selected and matched according to the diseased coronary artery and segment, lesion character and basic clinical data. The matched patients were divided into 2 groups:① digital angiographer group (DA),② traditional angiographer group (TA). Following parameters were compared between two groups: procedure success rate, major complications, mortality, surgical operation time, fluoroscopy time, number of times for positioning stent with cine, amount of radiation scattering with and without shielding, weight voltage index, projection change speed, imagine definition. Results Sixty patients were selected from 130 consecutive geriatric percutaneous coronary intervention(PCI) cases . Twenty eight cases were matched on the proximal lesion of left anterior descending artery (LAD) and 32 cases matched on the proximal lesion of right coronary artery (RCA). The basic clinical data and coronary lesion characters were comparable between DA and TA groups (P0.05). DA had more advantages than TA in all aforementioned parameters ( P 0.05). The digital angiographer was also far more superior to the traditional one in image definition, anatomical gradation and equipment differentiation. Conclusions The new digital angiographer has better image definition, anatomical gradation and equipment differentiation and less radiation scattering amount than traditional angiographer. These characters are benefitial to the effectiveness and safety of geriatric PCI procedures.