Percutaneous myocardial revascularization (PMR)，building on the succeeds of transmyocardial laser revascularization (TMR)，has developed that allows TMR-like channels to be cradated via a percutaneous approach.This catheter based approach avoids the morbidity associated with general anesthesia and thoractomy or thoracoscopy.It also avoids transmural treatment of the myocardium by the laser.Although its mechanism remains unclear,many patients with intractable angina and non-bypassable coronary artery disease have benefited from the new system.It is hoped that PMR will mimic the clinical benefit of TMR，and will gradually become a main method in treating end-staged coronary artery disease.

Objective To evaluate the feasibility, and clinical efficacy of combined interventional procedure (CIP) in composite cardiovascular diseases (CCD). Methods Twenty one consecutive patients were diagnosed as CCD before the procedures. The algorithm of CIP were individualized by the operators and physicians. The criteria for a successful procedure were defined before the operation. The counterplan for predictable complications was also established beforehand. The successful rate, short and long term efficacy, the incidence of complications and adverse reaction associated with contrast medium and X-ray were observed. All the patients were followed up through special out-patient clinic, telephone, or letters. Results Seven cases accepted electrophysiological testing(EPT) + radiofrequency catheter ablation (RFCA)+coronary angiogram (CAG)+percutaneous transluminal coronary angioplasty (PTCA)+stent implantation (SI). Four cases accepted CAG+PTCA+SI+EPT. Three cases accepted EPT+RFCA+CAG. Six cases accepted CAG+PTCA+SI+peripheral artery angiogram (PAG). One cases accepted pacemaker implantation (PI)+CAG+PTCA+SI+percutaneous transluminal septal myocardial ablation (PTSMA). The symptoms of arrhythmia disappeared or alleviater in 19 cases during hospiatalization. Arrhythmia recurred in 2 cases 12 hours after the procedure and accepted RFCA again. No severe complications and adverse reaction occured. The successful rate was 90.5 percent. Two cases suffered from recurrent angina during the follow-up period and one of them had in-stent restenosis proved by CAG and accepted PTCA+SI again. The other patient received medicine therapy. Conclusion Combined interventional procedure operated by experienced interventional cardiologist in a conditioned catheterization laboratory is safe and feasible. The short-term outcomes are satisfied. The long-term outcomes will be proved by accumulating more cases' data. Individualized approaches, counterplans for complications and cautious operation are important to a successful procedure.

Objective To evaluate the merits and demerits of three different closure methods for femoral artery access site in the interventional therapeutic procedures for senile patients with coronary artery disease. Methods We managed the femoral artery access sites in 60 cases undergoing interventional operation using three different hemostasias, including manual compression, Femostop equipment and Perclose suture (20 cases for each group). The procedure time, time for patients staying in bed, expenditure obedience, the percentage of procedure failure and vagal vascular reflex, and local vascular complications were observed and analyzed statistically. Results The study showed that the procedure time in Perclose suture group was about 12 minutes, much shorter than that in finger pressing and Femostop equipment groups (respectively 23 and 55 minutes, P

Objective The aim of the study is to explore the relationship of lung infection(LI)and multiple organ failure in the elderly(MOFE).Methods Consecutive patients ,who were admitted to the Institute of Geriatric Cardiovascular Diseases of the PLA General Hospital and the Endocardial Department of the Air Force General Hospital,withage≥65 years old were enrolled into 5 groups retrospectively by following criteria:acute LI alone,LI with the first presentation of acute lung edema,chronic bronchitis complicated with LI,chronic heart failure complicated with LI,and nic bronchitis and heart failure complicated with LI.Results Sixty-eight patients were selected of(72.5?7.6)years old ( 38 male).There were 4 cases of pure LI(4%),12 cases of LI firstly presented with the symptoms of acute lung edema(18%),16 cases of LI complicated with chronic bronchitis(24%),15 cases of LI based on chronic heart failure(22%)and 22 cases of LI complicated with chronic bronchitis and heart failure(32%).LI initiated MOFE in 25 cases(37%).Most of them were developed on the basis of chronic bronchitis and/or heart failure(34%).Mortality of secondary LI was higher than that of the primary LI(7.4% VS 0%,P

Objective To evaluated the effect of special nursing after coronary intervention in elderly.Methods 142 cases of consecutive patients with coronary artery disease were treated with percutaneous coronary intervention.According to the nursing models,the patients were divided into special nursing group(86 case) and routine nursing group(56 case).Results The incidence of aypnia,dysphoria,hospital onset of infection or other complication after intervention in special nursing group was less than that of routine nursing group.Conclusion The special nursing may accelerate the recovery of the old patients with coronary artery disease after coronary intervention.

The antagonistic effects of phentolamin(PL) and tolasuline(TS) on norepinephrine(NE)-induced vasoconstriction were investigated in vitro on aortic rings of normotensive and spontaneously hypertensive rats in Kreb-Henseilet solution containing 40?IU/ml insulin.The results showed that in the presence of high level insulin,the antagonistic actions of ?-receptor blocking agents,PL and TS,were markedly decreased.The pharmacodynamic parameters indicated that the affinity index and action intensity of PL and TS were significantly reduced in solution containing high level insulin.The experimental results showed that high concentration insulin could decrease the antagonistic effects of ?-receptor blocking agents on NE-induced vasoconstriction.

Objective: To study the effect of enalapril on inducible atrial fibrillation(AF) in old rats. Methods: Old male Wistar rats were randomly divided into control group(n = 12) and experimental group(n = 13). Rats in control group were fed routinely. Rats were fed with enalapril besides normal diet in experimental group for three months. Rats were then anesthetized, thoracotomy was performed and pericardium was opened to expose heart. Right atrium effective refractory period(ERP) was measured. Sinus conduction time (SCT) and sinus recovery time (SRT) were measured for evaluating sinus function. Interatrial conduction time(IACT) and atrium response to burst pacing were evaluated in vivo. Plasma angiotensinⅡ level and atrial tissue angiotensinⅡ level were determined by radioimmunoassay. Sections were cut from the tissue of atrium and stained with Masson trichrome. The ratio of the area occupied by interstitial to the total area was measured. Results: Contrast to control group,IACT and SRT were shorter in experimental group(P ＜ 0.01 and P ＜ 0.05 respectively). AF were induced in 9 rats in control group and 4 rats in experimental group(P ＜ 0.05). AngiotensinⅡconcentration was significantly decreased in right and left atrium tissues of experimental group compared with that in control group(P ＜ 0.01). A significant decrease in interstitial atrial fibrosis was presented in experimental group compared with that of control group(P ＜ 0.01). Conclusion: Inducible atrial fibrillation rate was decreased in old rats after treatment with enalapril. This effect maybe resulted from the inhibited local atrium renin-angiotensin system and improved sinus node function by enalapril.

Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with coronary heart disease (CHD).Methods CRP was measured on admission in 177 consecutive elderly (age≥60 years) patients with CHD who underwent coronary angiography. Patients were divided into high CRP group (CRP≥3mg/L) and normal CRP group (CRP ＜3mg/L). The association between CRP levels and the coronary lesion features, including severity of stenosis (mild, moderate, severe), extent of lesion (diffused or nondiffused), eccentricity of the plaque (eccentric or non-eccentric) were analyzed. Patients were followed up for a mean of 8 months for the occurrences of major adverse cardiac events (MACE). Results Compared with patients in normal CRP group, patients in high CRP group were more frequently to have unstable angina, multi-vessel, diffuse, eccentric lesions, positive remodeling, and non-smooth plaques (P＜0.01). Kaplan-Meier analysis showed patients in high CRP group had a significantly lower MACE-free survival rate than patients in normal CRP group (Log-rank = 12.0, P＜0.01); Cox regression analysis indicated CRP level as an independent predictor for the occurrence of MACE (OR=3.16, P＜0.05) Conclusions High CRP level is associated with more extend, severe and eccentric coronary lesions and is an independent predictor for MACE in elderly patients with CHD.

Objective To explore the effect of aerobic exercise on platelet function in elderly patients with hypertension and type 2 diabetes.Methods81 elderly patients with hypertension and type 2 diabetes were divided into the routine treatment group (group A, n=41) and regular exercise group (group B, n=40). All patients of two groups were treated with routine treatment. The exercise with moderate intensity was performed in the group B for 3 months besides routine treatment. The platelet membrane glycoprotein CD62P, CD61 (Ⅲa) were detected by flow cytometric analysis and platelet aggregating ratio was measured before and after regular aerobic exercise.ResultsAfter three months, the systolic blood pressures were 166±3.6 mm Hg (group A) and 152±3.5 mm Hg (group B); the diastolic blood pressures were 93±4.2 mm Hg (group A) and 83±4.3 mm Hg (group B); the contents of blood glucose were 7.4±2.4 mmol/L (group A) and 6.3±1.9 mmol/L (group B); the positive percents of platelet membrane glycoproten CD62P were 27.3±2.2% (group A) and 21.5±3.3% (group B), CD61(Ⅲa) were 26.3±2.3% (group A) and 20.2±2.9% (group B) and platelet aggregation rates were 78.4±4.5% (group A) and 69.7±5.4% (group B), there was a significant difference between two groups ( P<0.05～0.01).ConclusionRegular aerobic exercise can decrease the positive percent of platelet membrane glycoprotein and platelet aggregation rate in elderly patients with hypertension and type 2 diabetes.

Background and Objectives The relationship between left atrial (LA) size and congestive heart failure (CHF) is well recognized;however, there is little information on the association of pulmonary vein (PV) diameter and CHF.The purpose of this study was to investigate the changes of PV and LA sizes in CHF patients by multislice computed tomography (MSCT) angiography using a new 64-slice scanner. Methods and Results We assessed diameters of PVs ostium and LA by 64-slice MSCT with three-dimensional reconstruction in 25 CHF patients and in 26 age- and sex-matched non-CHF controls. Compared with controls, CHF patients showed significant greater diameters of left superior pulmonary vein (LSPV) and right inferior pulmonary vein (RIPV) in both anteriorposterior(AP) and superior-inferior (SI) directions (P＜0.01), significant dilation of right superior pulmonary vein (RSPV) in AP direction (P＜0.05), as well as significant increase of LA transverse, AP, and SI diameters (P＜0.01). Conclusion Significant dilation of PVs with simultaneous LA enlargement was demonstrated in CHF patients. This anatomic and geometric changes may participate in the perpetuation of AF.