Effect of Dual Chamber Atrioventricular Sequential Pacing on Coronary Flow Velocity in a Patient with Hypertrophic Obstructive Cardiomyopathy

Effects of dual chamber A V sequential pacing on coronary flow velocity, especially systolic reversal flow, were tested in a patient with hypertrophic obstructive Cardiomyopathy. AV sequential pacing with shorter AV delays reduced the systolic reversal flow in the coronary artery, and improved the pressure gradient of the left ventricular outflow tract.     

皮腔内冠状动脉成形术和支架植入术的临床应用

目的 :探讨经皮腔内冠状动脉成形术 (PTCA)和支架植入在冠心病治疗中的应用。方法 :总结 68例已行PT CA和支架植入的冠心病患者治疗效果 ,其中 82处病变进行PTCA术 ,76处病变植入支架 ,2例术后 1个半月至 4月再发心绞痛 ,1例术后出现上消化道大出血及下腹腔血肿 ,无其他严重的并发症及死亡发生。结论 :PTCA和支架植入术是冠心病患者安全有效的治疗方法     

Holmium laser coronary thrombolysis--a new treatment modality for revascularization in acute myocardial infarction: review

Thrombolytic therapy has changed the approach to management of acute myocardial infarction (AMI). Although its therapeutic benefit has been well established, only about one-third of AMI patients receive lytics. In AMI patients for whom thrombolytics fail to achieve revascularization or for whom lytics are contraindicated, percutaneous transluminal coronary balloon angioplasty (PTCA) can be utilized. However, in a clinical setting of AMI PTCA is less successful and is associated with a higher complication rate than with PTCA for angina alone. This review details a novel application of laser angioplasty; in patients with AMI complicated by continuous chest pain and ischemia, a mid-infrared (2.1 micron) solid-state, pulsed-wave Holmium:YAG coronary laser (Eclipse, Palo Alto, CA) can be utilized for coronary thrombolysis and plaque ablation. In each patient the laser was applied after failure of a thrombolytic agent or when thrombolytics were contraindicated. We have gained experience with 13 lesions, 12 in a coronary artery and 1 in a vein graft. In each case a multifiber with laser catheter (1.4, 1.5, 1.7 or 2.0 mm) was advanced over a guide wire, emitting 250-600 mj/pulse at 5 Hz, followed by adjunctive PTCA. Clinical success (defined as less than or equal to 50% residual stenosis, adequate thrombolysis, no complications [including death, CVA, CABGs, dissection, perforation]) was achieved in all patients. All patients improved clinically, survived the AMI, and were discharged. This initial clinical experience demonstrates the feasibility and safety of Holmium:YAG coronary laser angioplasty in revascularization during AMI.(ABSTRACT TRUNCATED AT 250 WORDS)     

Health-related quality of life among patients undergoing percutaneous transluminal coronary angioplasty

A randomized clinical trial was recently conducted to investigate whether a new antiplatelet agent could prevent restenosis in patients who had undergone percutaneous transluminal coronary artery angioplasty (PTCA). Approximately 1,200 patients were enrolled at 13 separate clinical sites. To assess the impact of this intervention on health-related quality of life, a patient questionnaire for telephone administration was developed. This questionnaire focused attention on several specific dimensions likely to be important in this patient population: physical well-being, perceived health, emotional well-being, home management, work, recreation, and social and sexual functioning. This paper describes the instrument that was used in this trial and reports on its psychometric [corrected] properties based on completed interviews with approximately 500 patients at study entry and 1 month after PTCA.     

经皮腔内冠状动脉成形术后内皮素心脏释放动力学的研究

目的　对经皮腔内冠状动脉成形术 (PTCA)后内皮素 (ET)释放的动力学进行估价 ,探讨冠状动脉内皮是否是ET的释放部位。方法　 12例冠脉造影前后、2 0例陈旧性心肌梗死行择期PTCA术前及术后 5min、6h的股静脉血、冠状动脉口血及冠状窦处血 ,用放射免疫法检测ET浓度。结果　冠脉造影前后血浆ET浓度无明显变化 (P >0 0 5 )。PTCA术后 5minET浓度升高 ,与术前相比具有极显著性差异 (P <0 0 1) ,且持续升高达 6h ,与术前相比具有极显著性差异 (P <0 0 1)。PTCA后冠状动脉口、冠状窦及股静脉处ET浓度均明显升高 ,但冠状窦处最高 ,其与冠状动脉口及股静脉相比均具有显著性差异 ,且冠状动脉口与股静脉处ET浓度相比也具有显著性差异。结论　PTCA可使血浆ET进一步升高 ,冠状动脉内皮可能是ET的释放源     

准分子激光与旋磨术在冠状动脉支架再狭窄治疗中的作用

目的比较准分子激光与旋磨及常规球囊对冠状动脉支架内再狭窄治疗的效果。方法将461例单支冠状动脉病变支架内再狭窄患者分别用准分子激光、旋磨术与常规球囊进行扩张治疗,并在治疗后即刻及6个月时再次行冠状动脉造影并进行定量分析。结果介入治疗前各组间支架内再狭窄情况无明显区别;准分子激光和旋磨后加PTCA即刻所获得的冠状动脉支架内最小血管直径(MLD)显著高于常规球囊治疗组(P<0.05),且旋磨与准分子激光组间无明显差异(P>0.05);6个月后准分子激光及旋磨组治疗组冠状动脉支架内血管直径明显低于常规球囊治疗组(P<0.05),且旋磨及准分子激光组无显著性差异(P>0.05)。旋磨与准分子激光及常规球囊治疗组支架内血管直径狭窄率分别为57.17%、54.78%及38.31%;准分子激光及旋磨组后期血管丢失量高于常规球囊治疗组(P<0.05)。结论准分子激光及旋磨对冠状动脉支架内再狭窄即刻疗效明显优于常规球囊治疗组,但6个月后支架内再狭窄率高于常规球囊治疗组,因而不宜首选用作支架内再狭窄的治疗。     

经皮冠状动脉成形术中的冠状动脉破裂原因分析

目的：探讨冠状动脉成形术中冠状动脉破裂的可能原因。方法：对所有介入治疗前的靶病变行定性和定量造影分析,并选择在发生冠状动脉破裂前最近一次的血管内超声（IVUS）图像进行分析。结果：在5个心脏介入中心总共1 506例经皮冠状动脉成形术（PCI）患者中,发生冠状动脉破裂15例（1.0%）,其中6例与操作导丝相关,1例与单纯球囊扩张相关,8例与支架植入相关。6例与导丝相关的破裂均由亲水涂层或中等硬度导丝所致,靶病变包括3例闭塞、4例偏心和3例分叉病变。与球囊或支架相关冠状动脉破裂包括6例偏心、6例中等至严重钙化病变。有血管内超声分析的5例,其病变偏心率均小于0.4,钙化弓在42~109度。除了单纯球囊破裂病例,在所有支架植入导致的破裂,球囊/管腔比值均超过1.3。所有与导丝相关冠状动脉破裂属于EllisⅡ级,与球囊或支架相关的2例属Ⅱ级,7例属Ⅲ级。结论：导丝相关的冠状动脉破裂常发生在采用亲水涂层或中等硬度导丝对偏心、分叉或闭塞病变进行操作;球囊或支架相关冠状动脉破裂经常与球囊尺寸过大或压力过大有关,常发生在偏心和伴钙化的病变处。     

Evaluation of coronary arterial stenoses before and after percutaneous transluminal coronary angioplasty using magnetic resonance coronary angiography

Summary

X ray coronary angiography has become an indispensable technique for assessing coronary heart disease. However, repeated angiography causes various complications in some patients. We evaluated coronary stenoses non-invasively, before and after percutaneous transluminal coronary angioplasty (PTCA), using magnetic resonance coronary angiography (MRCA). Twenty-four patients underwent MRCA and PTCA. MRCA was performed using a gradient echo sequence with K-space segmentation. MRCA images were classified as normal, vessel narrowing, reduced intensity, breakage of vessel and inability to image. MRCA performed before PTCA showed abnormal findings in all patients (reduced intensity in five, vessel narrowing in four, breakage of vessel in 13, inability to image in two). Although every patient underwent successful PTCA, MRCA performed after PTCA showed abnormal findings (reduced intensity in seven, vessel narrowing in five) in half the patients. Patients who had complex lesions had a tendency to exhibit abnormal findings in MRCA. MRCA provided useful information parallel to X ray angiography before PTCA. However, after successful PTCA, it still showed abnormal findings in half the patients. It was considered that MRCA over-estimates medium stenoses-and has difficulty imaging complex lesions or tortuous vessels. It was concluded that MRCA has potential as a non-invasive examination technique to image coronary arteries before and after PTCA.     

Coronary angioplasty in black and white patients: demographic characteristics and outcomes

BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) is an effective means of revascularization, but differences may exist in application and outcomes for patient subgroups. Few data compare PTCA in black and white patients. METHODS: We compared patient characteristics and outcomes of PTCA in 3,447 white patients and 52 black patients. RESULTS: Comparing baseline characteristics, more black patients were hypertensive (87% vs 57%) or diabetic (38% vs 22%). Procedural success was similar, and in-hospital complications were infrequent in both groups. Over a mean follow-up of 115 weeks, no significant difference occurred between the two groups in nonfatal MI, repeat PTCA, coronary artery bypass grafting, or death. Event-free survival was lower in blacks than in whites. CONCLUSIONS: At our center, black patients have success rates, in-hospital outcomes, and long-term survival after PTCA similar to those of white patients, though event-free survival was lower in blacks.     

食道调搏心负荷二维超声心动图试验评价冠心病介入性治疗疗效

目的 探讨ＴＥＡＰ－２ＤＥ试验对ＣＨＤ诊断价值及其一对介入性治疗效果的评价。方法 １９９５年４月￣１９９８年９月之间３８例在我院住院的ＣＨＤ患,先期行ＴＥＡＰ－２ＤＥ试验及ＣＡＧ检查,并在１周后接受冠状动脉介入性治疗（ＰＴＣＡ或ＰＴＣＡ＋Ｓｔｅｎｔ）,分别在１、３、６、１２个月用ＴＥＡＰ－２ＤＥ评价介入治疗的效果。结果 ＴＥＡＰ－２ＤＥ与ＣＡＧ相比,检出冠脉狭窄的符合率相似。ＴＥＡＰ－２ＤＥ观察     

Alternate pacing sites for patients with tricuspid valve prostheses

The objective of this study was to pace via a coronary vein to avoid interfering with the tricuspid valve prosthesis function. Pacing leads were inserted into the posterior cardiac vein in a 68-year-old woman (patient 1), and in the great cardiac vein and the right auricle in a 32-year-old woman (patient 2). In patient 1 the stimulation threshold was 1.8 V at implant and stabilized at 3.0 V at the 24-month follow-up. In patient 2 the ventricular pacing threshold was 1.2 V at implant and stabilized at 0.7 V at the 24-month follow-up. The cardiac output at rest increased 43% during atrioventricular synchronous pacing compared to ventricular pacing. Long-term stable ventricular pacing via the coronary venous system was obtained.     

The role of angioplasty in acute myocardial infarction

The role of percutaneous transluminal coronary angioplasty (PTCA) in the management of acute myocardial infarction (AMI) has not yet been precisely defined. The longest experience with PTCA in this setting has been in patients who are not candidates for thrombolytic therapy and in patients in whom thrombolysis has failed. Clinical interest has recently focused on direct use of PTCA (instead of thrombolysis) as the initial approach to reperfusion in AMI. We review the conceptual bases for both thrombolytic therapy and PTCA in AMI, and we then detail the clinical experience with PTCA in a variety of patient populations with AMI to guide use of both therapies in this setting.     

Acute myocardial infarction and rescue percutaneous transluminal coronary angioplasty in a young HIV-infected patient

We report a case of acute myocardial infarction in an HIV-infected patient without significant coronary artery disease (CAD) risk factors. The patient underwent rescue percutaneous transluminal coronary angioplasty (PTCA), with a successful outcome. We presume a possible pathogenetic role of anti-retroviral therapy and/or direct viral action on ischaemic heart disease progression. We propose that the current approach to management of AIDS-affected patients needs close monitoring for CAD risk factors and symptoms, to improve prognosis and life expectancy.     

多巴酚丁胺负荷超声评价行经皮经腔冠状动脉成形术及支架植入术后再狭窄

目的 探讨多巴酚丁胺负荷超声心动图(DSE)评价行经皮经腔冠状动脉成形术(PTCA)及支架植入术后再狭窄的临床应用价值.方法 39例行PTCA或支架植入术后1～12个月的患者,在造影前1周内接受DSE检查,多巴酚丁胺剂量递增方案为5、10、20、30、40μg·kg-1·min-15个级别,每级负荷维持3分钟.比较DSE和造影检查结果的一致性.结果 DSE评价PTCA及支架植入术后再狭窄的敏感度为75.0%,特异度为92.6%,准确度为87.2%.结论 DSE评价PTCA及支架植入术后再狭窄具有准确、安全可行的特性.     

Reducing pain and discomfort following percutaneous transluminal coronary angioplasty

Although percutaneous transluminal coronary angioplasty (PTCA) has been found to be an effective alternative to open-heart surgery for patients with coronary artery disease, the procedure itself can be associated with severe anxiety and discomfort for the patient. The authors report the discomfort patients experience during recovery from PTCA and suggest nursing interventions to reduce pain for these patients.     

Percutaneous transluminal coronary angioplasty in patients over 75 years old with acute myocardial infarct or unstable angina pectoris

Both increasing frequency and technical improvements of percutaneous transluminal coronary angioplasty (PTCA) have focussed attention on possible applications of PTCA in elderly patients with coronary artery disease. From January 1986 to June 1989, among 1872 patients treated with PTCA in our hospital, 42 patients (2.3%) were 75 or more years old. Of these patients, 14 presented with unstable angina, 28 patients suffered from acute myocardial infarction. PTCA was performed on stenoses of left anterior descending artery (43%), circumflex coronary artery (18%), and right coronary artery (39%), respectively. In patients with unstable angina, PTCA in 81% could reduce diameter stenoses of culprit lesions to 50% or less. 43% of patients with acute myocardial infarction had received previous thrombolytic therapy with streptokinase or urokinase applied either systemically or intracoronarily. On cardiac catheterization, 39% of patients presenting with acute myocardial infarction showed total occlusion of the infarct-related vessel. In 75% of patients with acute myocardial infarction, after PTCA, patency of the infarct-related artery (diameter stenoses 50% or less) was observed. In-hospital mortality of patients with acute myocardial infarction subjected to PTCA was 10%, two patients dying in prolonged cardiogenic shock, one in septic shock. In 20% of cases, coronary dissection was observed after PTCA. Non-Q-wave infarction developed in one patient. Three patients had a peripheral vascular complication, and in one patient a transient ischemic attack was observed. No severe catheter-related complications occurred after thrombolytic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of restenosis in determining adverse outcome after coronary angioplasty vs bypass surgery

A group of patients who did not have restenosis after percutaneous transluminal coronary angioplasty (PTCA) was compared with a group receiving coronary artery bypass grafting (CABG). Restenosis only partially accounted for the greater morbidity after PTCA compared with CABG.     

Emergency angioplasty and stent deployment for acute occlusion of an anomalous single coronary artery (all three coronary arteries from one ostium in the right sinus of Valsalva)

A single coronary ostium is traditionally considered to be of little clinical significance. We report a case of a single ostium in the right sinus of Valsalva, giving rise to the right coronary artery, from which the left main coronary artery originated. Sudden death occurred seven days after acute gastrointestinal bleeding and subsequent interruption of aspirin therapy. Acute coronary angiography following successful resuscitation revealed an ascending thrombus in the right coronary artery. The patient underwent a complex percutaneous coronary angioplasty with stent deployment. We conclude that coronary artery disease may lead to severe ischemia with a large area at risk and major complications in patients with coronary anomalies. Patients with acute stent implantation might benefit from platelet aggregation even in cases of recent intestinal bleeding.     

Abnormal postsystolic thickening in acutely ischemic myocardium during coronary angioplasty: a velocity, strain, and strain rate doppler myocardial imaging study.

We report a case in which the combination of gray scale imaging of wall thickness changes allied to color DMI regional velocity, strain, and strain rate data identified the development and regression of diastolic thickening in the acute ischemic segment during a right coronary artery percutaneous transluminal coronary angioplasty (PTCA). We also discuss the possible mechanisms and potential clinical implications of this finding.     

选择性PTCA及冠脉内支架置入术的护理探讨

目的 探讨对选择性PTCA及冠脉内支架置入术患者的整体护理。方法 回顾性分析1999年3月-2001年3月在我院实施经皮腔内冠状动脉成形术（PTCA）及冠状动脉内支架术（Stenting)的86例患者的临床资料，重点总结此术式患者主要的护理诊断和措施。结果 通过接受健康宣教及精心的治疗和整体护理，本组实施PTCA 支架术的86例患者顺利康复，无护理并发症发生。结论 运用护理程序何等好患者住院评估、心理护理、术前准备、术中监护、术后护理，是提高PTCA及支架术的临床护理质量，改善患者生活质量的关键。