Coronary Sinus Stent: Could It Help in Refractory Chronic Stable Angina?

Refractory angina is a life-disabling disease, even with the discovery of antianginal drugs and the advances in revascularization surgically or percutaneously to improve symptoms. Over the last decade a renewal of interest in an old surgical modality of narrowing the coronary sinus has evolved. Although the surgical procedure idea was born in 1940 it was overshadowed by the development of coronary artery bypass graft and percutaneous interventions. Recently, a percutaneous approach of reducing the coronary sinus size has been developed and several clinical studies have been reported in refractory angina patients. We review the history of coronary sinus intervention, and explore coronary sinus stent possible mechanism of action, device design, and the clinical data supporting its use.     

Paraseptal Accessory Pathway in Wolff-Parkinson- White-Syndrom: Ablation from the Right,from the Left or within the Coronary Sinus/Middle Cardiac Vein?

Aims: In 1999 the consensus statement living anatomy of the atrioventricular junctions was published. With that new nomenclature the former posteroseptal accessory pathway (APs) are termed paraseptal APs. The aim of this study was to identify ECG features of manifest APs located in this complex paraseptal space.Methods and Results: ECG characteristics of all patients who underwent radiofrequency ablation of an AP during a 3 year period were analyzed. Of the 239 patients with one or more APs, 30 patients had a paraseptal AP with preexcitation. Compared to APs within the coronary sinus (CS) or the middle cardiac vein (MCV) the right sided paraseptal APs significantly more often showed an isoelectric delta wave in lead II and/or a negative delta wave in aVR. The left sided paraseptal APs presented a negative delta wave in II significantly more often compared to the right sided APs.Conclusions: According to the site of radiofrequency ablation, paraseptal APs are classified into 4 subgroups: paraseptal right, paraseptal left, inside the CS or inside the MCV. Subtle differences in preexcitation patterns of the delta wave as well as of the QRS complex exist. However, the definitive localization of APs remains reserved to the periinterventional intracardiac electrogram analysis.     

Coronary Sinus Reducer Implantation for the Treatment of Chronic Refractory Angina: A Single-Center Experience

Objectives

The aim of this study was to assess the safety and efficacy of the Reducer in a real-world cohort of patients presenting with refractory angina.

Glycoprotein IIb/IIIa Blockers in Non-ST Elevation Acute Coronary Syndromes: Only for Well Defined Subgroups or a Therapeutic Option for All Patients?

Antiplatelet treatment of acute coronary syndrome without ST-elevation consists of aspirin and clopidogrel. Intravenous, but not oral glycoprotein IIb/IIIa receptor antagonists on top of this may be used in high-risk individuals, especially when they undergo early angioplasty, but these recommendations are derived from post-hoc analyses. They should be confirmed in future randomized trials in high risk patients. So far, glycoprotein IIb/IIIa receptor antagonists should not be used as a routine in patients with acute coronary syndrome without ST-elevation.     

“All in One”技术在“一站式”经导管主动脉瓣置换术联合经皮冠状动脉介入治疗术中的应用

目的 总结“All in One”技术在“一站式”经导管主动脉瓣置换术联合经皮冠状动脉介入治疗（PCI）中应用的初步经验。方法 连续收集2021年7月至2022年9月首都医科大学附属北京安贞医院心脏瓣膜病介入中心在“一站式”经导管主动脉瓣置换术联合PCI中应用“All in One”技术的患者27例进行回顾性分析,总结临床资料、影像学资料、手术操作、住院和出院随访期间主要不良心脑血管事件的发生情况。结果 27例患者平均年龄（74.1±7.8）岁;男15例,女12例;平均美国胸外科医师协会评分（6.02±3.25）%;主动脉瓣重度狭窄22例,单纯主动脉瓣重度反流5例;三叶式主动脉瓣20例,二叶式主动脉瓣7例。术前平均跨主动脉瓣血流速度（4.2±1.2）m/s,跨主动脉瓣平均压差（52.1±13.3）mmHg。所有患者均置入药物洗脱支架,其中左主干病变4例,多支血管病变11例,平均置入支架数量（1.8±0.9）枚,应用冠状动脉斑块旋磨术1例。所有患者在PCI术后均置入自膨胀瓣膜,术中无死亡、心肌梗死、脑卒中、急诊转外科手术、血管并发症发生,1例患者行瓣中瓣手术,无中重度瓣周反流。住院期间无...