Xiang-qian Shen

Effect of Delayed vs Immediate Stent Implantation on Myocardial Perfusion and Cardiac Function in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention With Thrombus Aspiration

BACKGROUND Optimizing microcirculation in STEMI patients with thrombus-containing lesion undergoing percutaneous coronary intervention (PCI) remains challenging. Our objective was to compare the effects on myocardial perfusion and cardiac function of delayed vs immediate stent implantation after thrombus aspiration in STEMI patients undergoing PCI. METHODS Eighty-seven STEMI patients with thrombus-containing lesion undergoing PCI were enrolled. After thrombus aspiration was performed, subjects were divided into 2 groups according to residual thrombus score (TS): immediate stent implantation (ISI) group (n = 47, residual TS < 2; stenting was performed immediately), and delayed stent implantation (DSI) group (n = 40, residual TS ≥ 2; stenting was performed 7 days later). Corrected thrombolysis in myocardial infarction frame count and myocardial blush grade were analyzed immediately after PCI. The wall motion score index was assessed on admission and at 6-month follow-up. RESULTS At the end of the PCI procedure, the corrected thrombolysis in myocardial infarction frame count was significantly shorter and the myocardial blush grade 3 was more frequent in the DSI group than in the ISI group. Compared with the ISI group, the DSI group had a lower incidence of thrombus-related angiographic events, including distal embolization and no reflow. A significantly greater improvement in wall motion score index from baseline to 6-month follow-up was observed in the DSI group compared with the ISI group. CONCLUSIONS In STEMI patients presenting with thrombus containing lesion undergoing PCI, delayed stent implantation after thrombus aspiration leads to better myocardial perfusion and cardiac functional recovery in comparison with immediate stent implantation.

Complications associated with transcatheter closure of perimembranous ventricular septal defects

Objectives: To identify the complications associated with transcatheter closure of perimembranous ventricular septal defects (PmVSD) using the Amplazter PmVSD occluder (AGA Medical, USA). Methods: Between October 2002 and November 2006, transcatheter closure PmVSD was attempted in 210 patients and performed in 206 patients. Those patients were followed‐up for 6–24 months (mean, 10.6 ± 3.9 months) to identify the complications. Results: Device implantation was successfully accomplished in 206 of the 210 patients (98%). Serious complications such as high degree atrioventricular block (AV block), infective endocarditis, and device embolization occurred in eight cases (3.8%). Other complications including mild aortic or tricuspid regurgitation, femoral pseudoaneurysm, and femoral arteriovenous fistula occurred in four cases. Conclusions: Transcathter closure of PmVSD can be performed safely and successfully. But further studies should continue to evaluate the potential complications associated with this procedure.

Atrioventricular block: a serious complication in and after transcatheter closure of perimembranous ventricular septal defects.

Transcatheter closure is an effective approach for perimembranous ventricular septal defects (PMVSD). However, atrioventricular blocks (AVB) emerged possibly due to the close proximity of the PMVSD to the conduction system, but concern for the complication was not adequately emphasized. In this study, we report the incidence of AVBs, in and after transcatheter closure of a PMVSD, and the outcome of the complication in our center.

The effects and mechanisms of high loading dose rosuvastatin therapy before percutaneous coronary intervention in patients with acute coronary syndrome

atrial fibrillation: the Framingham study. N Engl J Med 1982;306(17):1018–22. [7] Movahed MR, Hashemzadeh M, Jamal MM. Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease. Int J Cardiol 2005;105(3):315–8. [8] Carson JL, Scholz PM, Chen AY, Peterson ED, Gold J, Schneider SH. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol 2002;40(3):418–23. [9] Kourliouros A, Karastergiou K, Nowell J, et al. Protective effect of epicardial adiponectin on atrial fibrillation following cardiac surgery. Eur J Cardiothorac Surg Feb 2011;39(2):228–32. [10] Lin YK, Chen YC, Chang SL, et al. Heart failure epicardial fat increases atrial arrhythmogenesis. Int J Cardiol May 25 2012, doi:10.1016/j.ijcard.2012.05.009.

The association between oxidative stress, activator protein-1, inflammatory, total antioxidant status and artery stiffness and the efficacy of olmesartan in elderly patients with mild-to-moderate essential hypertension

ABSTRACT This study investigated the change of oxidative stress, activator protein-1 (AP-1), inflammatory, total antioxidant status (TAS) and artery stiffness, and explored the relationship between these characteristics and the efficacy of olmesartan intervention in elderly patients with mild-to-moderate essential hypertension (EH). In total, 386 elderly patients with EH and 353 normotensive controls were recruited. All study subjects had oxidative stress markers, AP-1, inflammatory factors, TAS and brancial-ankle artery pulse wave velocity (ba-PWV) measured. In total, 193 elderly patients with EH were randomized to olmesartan and were matched with 193 normotensive controls to observe the change of index above mentioned before and after the treatment. Compared with the controls, superoxide dismutase (SOD) and TAS were significantly reduced in patients with EH, and malondialdehyde (MDA), AP-1, high-sensitivity C-reactive protein (Hs-CRP), Monocyte Chemoattractant Protein-1 (MCP-1), heart rate， endothelin-1 (ET-1), TAS and ba-PWV were significantly increased (P < 0.01 for all). Pearson’s correlation analysis showed that SOD and TAS were negatively related to AP-1 (P < 0.05 for all), and that blood pressure (BP), age, MDA, Hs-CRP, MCP-1, ET-1 were positively related to AP-1 (P < 0.01 for all). Multivariate linear regression analysis showed that BP, SOD, MDA, AP-1, Hs-CRP, MCP-1, ET-1, TAS, heart rate and age were independent risk factors for ba-PWV. After treatment with olmesartan, SOD and TAS were increased, while BP, heart rate, AP-1 and inflammatory factors were reduced with significant improvement in ba-PWV (P < 0.05 for all). More increase of arterial stiffness was reported in elderly hypertensive patients with greater oxidative stress, inflammatory, AP-1, heart rate, and lower TAS. Higher oxidative stress, AP-1 and inflammatory may predict higher arterial stiffness. Olmesartan may increase TAS, yet inhibit oxidative stress, AP-1, inflammatory, and heart rate with improved artery stiffness in elderly hypertensive patients.

Non-surgical repair of ventricular septal rupture after acute myocardial infarction

BACKGROUND Ventricular septal rupture (VSR) following myocardial infarction is a rare complication with high mortality. Although transcatheter closure has emerged as a less invasive method of VSR closure, the optimal timing and technique remain unclear. METHODS This is a single-center, retrospective, cohort study. Eleven patients that underwent transcatheter closure of post-AMI VSR from 2006 to 2013 at the Second Xiangya Hospital were included in this study. The clinical, procedural, and outcome data were analyzed. RESULTS VSR occurred in 4 patients at anterior, 4 at posterior, and 3 at apical ventricular septum. Atrial Septal Defect occluder was used in 2 patients, muscular Ventricular Septal Defect occluder was used in 6 patients, and Patent Ductus Arteriosus occluder was used in 3 patients. The median time between VSR diagnosis and transcatheter closure was 18 days (range, 13-30 days). The median size of the VSR was 12 mm (range, 8-17 mm). The occlusion device was deployed successfully in 10 of 11 patients. Three patients died between zero and seven days after the procedure (30-day mortality, 27.3%). Eight patients survived during a follow-up of 150-1960 days. A follow-up TTE showed no residual shunt in three patients and a trivial or small residual shunt in five patients. CONCLUSION Transcatheter closure of post-AMI VSR using Atrial Septal Defect, Ventricular Septal Defect, and Patent Ductus Arteriosus occluders is feasible and effective. If the clinical conditions permit, intervention can be delayed to the late phase (>2-3 weeks) after VSR diagnosis.

Silent Embolization of an Atrial Septal Defect Occluder Into the Right Ventricle Detected 20 Months Post-Implantation

A 64-year-old woman, who had undergone transcatheter closure of a secundum-type atrial septal defect (ASD) with a 38-mm Amplatzer septal occluder (ASO) 20 months earlier, was admitted with palpitations for 1 day. She had not received routine follow-up after the procedure. Cardiac examination revealed a grade III/VI systolic ejection murmur at the left upper sternal border. Chest x-ray revealed that the ASO device was located in the right ventricular area (Fig. 1A). Immediate transthoracic echocardiography confirmed that the ASO device had become dislodged and embolized into the right ventricle. The embolized device was oriented in the longitudinal plane, parallel to the direction of blood flow across the tricuspid valve (Fig. 1B). Although the patient remained hemodynamically stable, she was referred for urgent surgical retrieval of the device and closure of the defect. In surgery, the embolized occluder was identified in the right ventricular inflow tract and appeared to be firmly adhering to the tricuspid valve apparatus (Fig. 1C). The inferoposterior rim of the ASD was also found to be inadequate. The endothelialization status of the retrieved device revealed that embolization must have occurred months earlier (Fig. 1D). The ASD was closed with a bovine pericardial patch through the right atriotomy, and the tricuspid valve was repaired with a 32-mm CosgroveEdwards annuloplasty band (Edwards Lifesciences, Irvine,

Severe Mechanical Hemolysis After Transcatheter Closure of a Traumatic Ventricular Septal Defect Using the Amplatzer Atrial Septal Occluder.

Traumatic ventricular septal defect (VSD) resulting from chest trauma, either penetrating or blunt, is a relatively rare occurrence. Herein, we describe the case of a previously healthy 26-year-old man who presented with congestive heart failure, which was secondary to a large traumatic VSD following violent blunt chest trauma. The traumatic VSD was initially closed percutaneously using an Amplatzer atrial septal defect occluder. Post-device closure, however, the patient developed severe intravascular hemolysis refractory to medical treatment. The patient subsequently underwent surgical removal of the Amplatzer device, with concomitant VSD patch closure.

Severe Spinal Cord Ischemic Injury Secondary to Device Embolization after Transcatheter Closure of a Patent Arterial Duct

Percutaneous closure of patent arterial ducts with the Amplatzer Ductal Occluder has become an effective and widely accepted alternative to surgical management. Although rarely, the occluder can be dislodged after an initially successful deployment, and with catastrophic consequences. We describe such a case in a 12-month-old girl who underwent transcatheter closure of a patent arterial duct. After device deployment, the occluder embolized in the patients descending thoracic aorta, and severe spinal cord ischemic injury resulted. To our knowledge, ours is the first report of this complication after the deployment of an Amplatzer Ductal Occluder. We discuss pathophysiologic mechanisms that could expose patients to the risk of device dislodgment, and we review the relevant medical literature.

GW24-e2209 Relationship between plasma N-terminal pro brain natriuretic peptide (NT-Pro BNP) level and SYNTAX score in patients with stable angina pectoris

Objectives Recently, the prognostic role of N-terminal pro-brain natriuretic peptide (NT-pro BNP) in heart failure and coronary diseases has been demonstrated in many studies. SYNTAX score was pioneered as an anatomical-based risk score that aided in this decision-making process in appropriately informing patients electing to undergo coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). However is not known if there is a relation between NT-pro BNP levels and SYNTAX score (SS). A present study came to investigate the relationship between plasma NT-pro BNP level and extent and complexity of coronary lesions assessed using SS in patients with stable angina pectoris candidate for coronary angiography. Methods The study population included 203 consecutive patients with stable angina and intend for selective coronary angiography. SS was calculated in all participants, According to SS value,all subjects were divided into three groups: low risk (< 22), intermediate risk (23-32), and high risk (≥ 33).blood samples were drawn from femoral or radial artery for NT-pro BNP measurement just before the catheterisation of left coronary. Results Regarding the role of N terminal pro BNP for assessing severity of coronary lesions based on SS, The NT pro BNP level increased significantly as risk classification of SS upgraded (P < 0.05). Linear regression analysis showed that plasma NT-pro BNP level was significantly associated with SS (r = 0.314, P < 0.01). Conclusions NT-pro BNP can be a good parameter for predicting severity of coronary lesions. NT-pro BNP level was significantly associated with the extent and complexity of coronary artery disease.